PROVIDENCE MEDICAL GROUP – Pulmonary Disease Physician, NPI 1194099390
Pulmonary Disease Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for PROVIDENCE MEDICAL GROUP
101 W 8TH AVE
MOTHER GAMELIN CENTER 3RD FLOOR
SPOKANE, WA 992042307
Phone: (509) 474-2072
Type: Mailing
PO BOX 31001-4114
PASADENA, CA 911104114
Phone:
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: 2025-12-31
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Past revalidation due date
Earliest CMS due date was 2024-02-29 (831 days ago).
Enrollment records
22
Earliest due date
2024-02-29
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 |
|---|---|---|---|---|
| O20151217001381 | O | Clinic/Group Practice | ID | 2024-02-29 |
| O20190114001966 | O | Clinic/Group Practice | CO | TBD |
| O20190123000613 | O | Clinic/Group Practice | AK | 2025-11-30 |
| O20190124002741 | O | Clinic/Group Practice | CA | 2025-10-31 |
| O20190128001785 | O | Clinic/Group Practice | OR | 2025-12-31 |
| O20200413000199 | O | Clinic/Group Practice | MI | 2026-01-31 |
| O20200825000777 | O | Clinic/Group Practice | MO | 2026-03-31 |
| O20200826000649 | O | Clinic/Group Practice | FL | 2026-06-30 |
| O20200915001282 | O | Clinic/Group Practice | DC | 2026-08-31 |
| O20200922001453 | O | Clinic/Group Practice | NY | TBD |
| O20200924001132 | O | Clinic/Group Practice | NV | 2026-09-30 |
| O20200930002304 | O | Clinic/Group Practice | HI | 2026-10-31 |
| O20210223000008 | O | Clinic/Group Practice | TX | TBD |
| O20221227001892 | O | Clinic/Group Practice | MN | TBD |
| O20230406000320 | O | Clinic/Group Practice | AZ | TBD |
| O20240104000516 | O | Clinic/Group Practice | IL | TBD |
| O20241126002182 | O | Clinic/Group Practice | WI | TBD |
| O20241127001268 | O | Clinic/Group Practice | NE | TBD |
| O20250312003552 | O | Clinic/Group Practice | UT | TBD |
| O20250603000344 | O | Clinic/Group Practice | NC | TBD |
| O20250915000566 | O | Clinic/Group Practice | TN | TBD |
| O20251231001825 | O | Clinic/Group Practice | NJ | 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 99204)
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