Proliance ProSports Imaging NW MRI – Orthopaedic Surgery Physician, NPI 1952399123
Orthopaedic Surgery Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for Proliance ProSports Imaging NW MRI
Rainier Orthopedic Institute, 3801, 5th Street Southeast, Puyallup, Pierce County, Washington, 98374, United States
SUITE 110
PUYALLUP, WA 983742106
Phone: (253) 845-9585
Fax: (253) 435-4785
Type: Location
5th Street Southeast, Puyallup, Pierce County, Washington, 98373-1464, United States
PUYALLUP, WA 983742106
Phone: (253) 845-9585
Fax: (253) 848-1126
Type: Mailing
3801 5th St SE Ste 120
Puyallup, WA 983742106
Phone: (253) 864-4106
Fax: (253) 864-4143
Type: Location
20920 SR 410 E
Bonney Lake, WA 983916302
Phone: (253) 845-9585
Fax: (253) 848-1126
Type: Location
3801 5TH ST SE STE 110
PUYALLUP, WA 983742106
Phone: (253) 845-9585
Fax: (253) 435-4785
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: 2011-06-17
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Past revalidation due date
Earliest CMS due date was 2024-08-31 (647 days ago).
Enrollment records
1
Earliest due date
2024-08-31
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 |
|---|---|---|---|---|
| O20110617000452 | O | Multi-Specialty - Physician | WA | 2024-08-31 |
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 98374)
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