SPINE TEAM SPOKANE – Interventional Pain Medicine Physician, NPI 1780754499
Interventional Pain Medicine Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for SPINE TEAM SPOKANE
PO BOX 808
VERADALE, WA 990370808
Phone: (509) 363-3100
Fax: (509) 363-0300
Type: Mailing
1123 N EVERGREEN RD
SPOKANE VALLEY, WA 992161138
Phone: (509) 363-3100
Fax: (509) 363-0300
Type: Location
510 E Holland Ave
Spokane, WA 992181206
Phone: (509) 363-3100
Fax: (509) 363-0300
Type: Location
1117, North Evergreen Road, Veradale, Spokane Valley, Spokane County, Washington, 99216, United States
SUITE 2
SPOKANE, WA 992161138
Phone: (509) 363-3100
Fax: (509) 363-0300
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: 2022-01-10
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Past revalidation due date
Earliest CMS due date was 2025-09-30 (253 days ago).
Enrollment records
3
Earliest due date
2025-09-30
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 |
|---|---|---|---|---|
| O20040507001165 | O | Clinic/Group Practice | WA | TBD |
| O20050728001068 | O | Clinic/Group Practice | ID | TBD |
| O20220110000199 | O | Physician - Anesthesiology | WA | 2025-09-30 |
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 99037)
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