LIFELINE MEDICAL CENTER – Family Medicine Physician, NPI 1265160451
Family Medicine Physician
Main info
Contacts
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for LIFELINE MEDICAL CENTER
1915 NE Stucki Ave Ste 400
Hillsboro, OR 970066938
Phone: (814) 408-0014
Type: Location
2900 Westfork Dr Ste 401
Baton Rouge, LA 708270004
Phone: (814) 408-0014
Type: Location
3707 E Southern Ave Ste 1025
Mesa, AZ 852066202
Phone: (814) 408-0014
Type: Location
8875 Hidden River Pkwy Ste 300
Tampa, FL 336372087
Phone: (814) 408-0014
Type: Location
3597 E Monarch Sky Ln Ste 240
Meridian, ID 836461055
Phone: (814) 408-0014
Type: Location
698 12th St SE Ste 240-5
Salem, OR 973014039
Phone: (814) 408-0014
Type: Location
1925 NE Stucki Ave
Hillsboro, OR 970066945
Phone: (814) 408-0014
Type: Location
500 Galleria Dr
Johnstown, PA 159048906
Phone: (814) 408-0014
Type: Location
2855 Charlestown Rd Ste 300
New Albany, IN 471502691
Phone: (814) 408-0014
Type: Location
3159 Carpenters Park Rd
Davidsville, PA 159289223
Phone: (814) 408-0014
Type: Location
2101 Jackson St
Anderson, IN 460164388
Phone: (814) 408-0014
Type: Location
1201 Pacific Ave Ste 6
Tacoma, WA 984024393
Phone: (814) 408-0014
Type: Location
701 NE 136th Ave Ste 200
Vancouver, WA 986846937
Phone: (814) 408-0014
Type: Location
10121 SE Sunnyside Rd
Clackamas, OR 970155745
Phone: (814) 408-0014
Type: Location
35200 Dequindre Rd
Sterling Heights, MI 483104837
Phone: (814) 408-0014
Type: Location
321 Main St
Johnstown, PA 159011632
Phone: (814) 408-0014
Type: Location
3415 S Sepulveda Blvd Ste 1100
Los Angeles, CA 900347090
Phone: (814) 408-0014
Type: Location
2180 Satellite Blvd Ste 400
Duluth, GA 300974927
Phone: (814) 408-0014
Type: Location
1500 NW Bethany Blvd Ste 200
Beaverton, OR 970065236
Phone: (814) 408-0014
Fax: (503) 914-6422
Type: Location
2000 Town Ctr Ste 1900
Southfield, MI 480751152
Phone: (814) 408-0014
Fax: (814) 479-5906
Type: Location
2245 Texas Dr Ste 300
Sugar Land, TX 774791468
Phone: (814) 408-0014
Type: Location
13509 Lyndon B Johnson Fwy Ste 200
Garland, TX 750414704
Phone: (814) 408-0014
Type: Location
41 University Dr Ste 400
Newtown, PA 189401873
Phone: (814) 408-0014
Type: Location
6565 Americas Pkwy NE Ste 200
Albuquerque, NM 871108172
Phone: (814) 408-0014
Type: Location
1415 W 22nd St
Oak Brook, IL 605232074
Phone: (814) 408-0014
Type: Location
23077 Greenfield Rd Ste 455
Southfield, MI 480753740
Phone: (814) 408-0014
Type: Location
1500 NW BETHANY BLVD STE 200
BEAVERTON, OR 970065236
Phone: (814) 243-0414
Fax: (503) 914-6422
Type: Mailing
3159 CARPENTERS PARK RD
DAVIDSVILLE, PA 159289223
Phone: (814) 408-0014
Fax: (814) 479-5906
Type: Mailing
2101 JACKSON ST STE 109
ANDERSON, IN 460164386
Phone: (814) 408-0014
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: 2024-06-03
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 13 Medicare enrollment records; no due dates published yet.
Enrollment records
13
Earliest due date
Not assigned (TBD)
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 |
|---|---|---|---|---|
| O20230427002507 | O | Clinic/Group Practice | OR | TBD |
| O20230515001595 | O | Clinic/Group Practice | MI | TBD |
| O20230627003021 | O | Clinic/Group Practice | IN | TBD |
| O20230721002527 | O | Clinic/Group Practice | PA | TBD |
| O20230831004324 | O | Clinic/Group Practice | TX | TBD |
| O20231019002503 | O | Clinic/Group Practice | ID | TBD |
| O20231025001869 | O | Clinic/Group Practice | WA | TBD |
| O20231025002914 | O | Clinic/Group Practice | CA | TBD |
| O20231107001263 | O | Clinic/Group Practice | NM | TBD |
| O20231120000820 | O | Clinic/Group Practice | IL | TBD |
| O20231220003305 | O | Clinic/Group Practice | AR | TBD |
| O20231228000237 | O | Clinic/Group Practice | GA | TBD |
| O20240603003781 | O | Clinic/Group Practice | FL | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
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 97006)
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