South Island Primary and Immediate Care – Internal Medicine Physician, NPI 1043557333
Internal Medicine Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for South Island Primary and Immediate Care
1500 Commercial Ave
Anacortes, WA 982212235
Phone: (360) 331-3343
Fax: (360) 331-3373
Type: Location
920 N 1st St
Renton, WA 980575759
Phone: (360) 399-7732
Fax: (360) 312-3223
Type: Location
3145 SHADOWBROOK LN
OAK HARBOR, WA 982779031
Phone: (360) 929-4936
Type: Mailing
1690 LAYTON RD
FREELAND, WA 982499456
Phone: (360) 678-6576
Fax: (360) 678-3970
Type: Location
5577 VANBARR PL
FREELAND, WA 982499555
Phone: (360) 331-3343
Fax: (360) 331-3373
Type: Location
PO BOX 935
FREELAND, WA 982490935
Phone: (360) 331-3343
Fax: (360) 331-3373
Type: Mailing
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: 2013-04-23
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
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 |
|---|---|---|---|---|
| O20130423000303 | O | Clinic/Group Practice | WA | 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 98221)
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