St. John Medical Center-PeaceHealth Therapy and Wellness – Prosthetic/Orthotic Supplier, NPI 1184106437
Prosthetic/Orthotic Supplier
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for St. John Medical Center-PeaceHealth Therapy and Wellness
1115 SE 164TH AVE DEPT 358
VANCOUVER, WA 986838004
Phone: (360) 729-1462
Fax: (360) 729-3104
Type: Mailing
TRIANGLE MALL SUITE 16 1015 OCEAN BEACH HWY
LONGVIEW, WA 98632
Phone: (360) 501-3750
Fax: (360) 501-3751
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: 2018-10-22
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Past revalidation due date
Earliest CMS due date was 2026-04-30 (40 days ago).
Enrollment records
1
Earliest due date
2026-04-30
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 |
|---|---|---|---|---|
| O20181022003047 | O | Independently-Practicing Occupational Therapist | WA | 2026-04-30 |
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 98683)
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