Proliance Orthopaedics and Sports Medicine – Orthopaedic Surgery Physician, NPI 1508893066
Orthopaedic Surgery Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for Proliance Orthopaedics and Sports Medicine
510 8th Ave NE Ste 200
Issaquah, WA 980295436
Phone: (425) 392-3030
Fax: (425) 392-2564
Type: Location
18100 NE Union Hill Rd Ste 330
Redmond, WA 980523330
Phone: (425) 455-3600
Fax: (425) 455-3920
Type: Location
515 Minor Ave Ste 200
Seattle, WA 981042133
Phone: (425) 455-3600
Fax: (425) 455-3920
Type: Location
Ridgway Face & Aesthetic Center, 1231, 116th Avenue Northeast, Midlakes, Bellevue, King County, Washington, 98004, United States
SUITE 750
BELLEVUE, WA 980043804
Phone: (425) 455-3600
Fax: (425) 455-3920
Type: Location
1231 116TH AVE NE STE 750
BELLEVUE, WA 980043812
Phone: (425) 455-3600
Fax: (425) 455-3920
Type: Location
8th Ave NE, Issaquah, King County, Washington, 98029, United States
ISSAQUAH, WA 980295436
Phone: (425) 507-0733
Fax: (425) 283-5551
Type: Mailing
3101 NORTHUP WAY STE 201
BELLEVUE, WA 980041449
Phone: (425) 455-3600
Fax: (425) 455-3920
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: 2019-03-12
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Past revalidation due date
Earliest CMS due date was 2026-05-31 (7 days ago).
Enrollment records
1
Earliest due date
2026-05-31
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 |
|---|---|---|---|---|
| O20190312001310 | O | Physician - Orthopedic/Orthopedic Surgery | WA | 2026-05-31 |
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 98029)
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