PROVIDENCE HEALTH & SERVICES - WASHINGTON – Rural Health Clinic/Center, NPI 1205931508
Rural Health Clinic/Center
Main info
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for PROVIDENCE HEALTH & SERVICES - WASHINGTON
3360, Southwest 87th Avenue, Raleigh West, Portland, Metro, Washington County, Oregon, 97225, United States
PORTLAND, OR 972083360
Phone: (503) 893-7120
Fax: (425) 276-3215
Type: Mailing
PO BOX 31001-4114
PASADENA, CA 911104114
Phone: (503) 893-7120
Fax: (425) 276-3215
Type: Mailing
Northwest Pediatric Center, 18313, Paulson Street Southwest, Rochester, Thurston County, Washington, 98579, United States
SUITE A
ROCHESTER, WA 985799262
Phone: (360) 827-8400
Fax: (360) 273-7301
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2005-06-02
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Past revalidation due date
Earliest CMS due date was 2023-08-31 (1019 days ago).
Enrollment records
2
Earliest due date
2023-08-31
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| O20040622000640 | O | Clinic/Group Practice | WA | 2023-08-31 |
| O20050602000450 | O | Rural Health Clinic | WA | TBD |
What to do next
- Verify current status on the CMS Revalidation Lookup Tool immediately.
- Complete revalidation in PECOS or contact your Medicare Administrative Contractor (MAC).
- Overdue revalidation can lead to deactivation of Medicare billing privileges.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 97208)
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