PeaceHealth Medical Group – Internal Medicine Physician, NPI 1356309553
Internal Medicine Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for PeaceHealth Medical Group
1115 SE 164TH AVE DEPT 358
VANCOUVER, WA 986838004
Phone: (360) 729-2150
Fax: (541) 431-8213
Type: Mailing
PeaceHealth St. Joseph Medical Center, 2901, Squalicum Parkway, Parkview, Cornwall Park, Bellingham, Whatcom County, Washington, 98225, United States
BELLINGHAM, WA 982251851
Phone: (360) 734-5400
Fax: (360) 756-6830
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: 2025-11-16
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 10 Medicare enrollment records; no due dates published yet.
Enrollment records
10
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 |
|---|---|---|---|---|
| O20031118001062 | O | Clinic/Group Practice | WA | TBD |
| O20250718003586 | O | Clinic/Group Practice | TX | TBD |
| O20250926001407 | O | Clinic/Group Practice | NY | TBD |
| O20251009001194 | O | Clinic/Group Practice | CA | TBD |
| O20251009002788 | O | Clinic/Group Practice | OR | TBD |
| O20251013002949 | O | Clinic/Group Practice | NV | TBD |
| O20251014003638 | O | Clinic/Group Practice | OH | TBD |
| O20251015001874 | O | Clinic/Group Practice | GA | TBD |
| O20251019000201 | O | Clinic/Group Practice | CO | TBD |
| O20251116000060 | O | Clinic/Group Practice | TN | 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 98683)
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