Craig Dale

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA1619 Issued in ID

Practice address

441 N Tenmile LK
Lakeside, OR 97449-8648

Phone

(719) 239-1403

NPI assigned

May 12, 2015

Last updated

Feb 17, 2022By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other names 1

• Craig Dale Professional name

Medicare fee-for-service enrollment

Enrolled in WA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: cdale1653103@direct.trinity-health.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Cep America LLC

  dba Vituity

  • Emergency Medicine Physician
  • Edmonds, WA
  • NPI 1447484274
  Medicare reassignment
• Sound Physicians Emergency Medicine of Washington PLLC

  • Emergency Medicine Physician
  • Sedro Woolley, WA
  • NPI 1629532064
  Medicare reassignment
• Cep America LLC

  • Emergency Medicine Physician
  • Friday Harbor, WA
  • NPI 1962200790
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1431388800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1645056000000",
    "number": "1023496965",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "441 N TENMILE LK",
            "city": "LAKESIDE",
            "state": "OR",
            "postal_code": "974498648",
            "telephone_number": "719-239-1403"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "441 N TENMILE LK",
            "city": "LAKESIDE",
            "state": "OR",
            "postal_code": "974498648",
            "telephone_number": "719-239-1403"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DALE",
        "first_name": "CRAIG",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-05-12",
        "last_updated": "2022-02-17",
        "certification_date": "2022-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": "PA179589",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "PA60843540",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ID",
            "license": "PA1619",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CRAIG",
            "last_name": "DALE",
            "credential": "PA-C",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Foundations for Life Clinic LLC (Manzano Speech Therapy)
• Judy Anne Howard, RN, CFCN
• Deborah Louise Jensen, LCSW

• Physician Assistant in Lakeside, OR
• Providers in Lakeside, OR by specialty
• Physician Assistant in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.