Individual provider Active NPI

Charlotte Duvall, PA-S

  • Physician Assistant
  • Federal Way, WA
National Provider Identifier
1023664844
Registry record updated May 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
33915 1St Way S Ste 200
Federal Way, WA 98003-6396
Phone
(253) 838-9839
NPI assigned
Aug 16, 2019
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 13, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Physician Assistant 363A00000X PA61098760 WA
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

33915 1St Way S Ste 200
Federal Way, WA 98003-6396

Mailing address

3209 S 23Rd St Ste 340
Tacoma, WA 98405-1602
Phone (800) 734-6855

Other practice location 1

4311 11th Ave NE Ste 200
Seattle, WA 98105-6367
Phone (206) 616-4001

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20210119001465 WA Practitioner - Physician Assistant 7517370240 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as apm

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Washington Gastroenterology PLLC Physician Assistant CurrentSince Sep 1, 2024 Accepting new patients

Locations

33915 1st Way S
Ste 200
Federal Way, WA 98003
Phone (253) 838-9839

17700 SE 272nd St
Ste 420
Kent, WA 98042
Phone (253) 639-9660

1703 S Meridian
Ste 203
Puyallup, WA 98371
Phone (253) 841-3933

1703 S Meridian
Ste 305
Puyallup, WA 98371
Phone (253) 841-3933

3209 S 23rd St
Ste 200
Tacoma, WA 98405
Phone (253) 503-2508

3209 S 23rd St
Ste 340
Tacoma, WA 98405
Phone (253) 272-8148

Organizations & group practices 4

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

NPI Registry JSON

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

{
    "created_epoch": "1565913600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715558400000",
    "number": "1023664844",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3209 S 23RD ST STE 340",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984051602",
            "telephone_number": "800-734-6855"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "33915 1ST WAY S STE 200",
            "city": "FEDERAL WAY",
            "state": "WA",
            "postal_code": "980036396",
            "telephone_number": "253-838-9839"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4311 11th Ave NE Ste 200",
            "address_purpose": "LOCATION",
            "city": "Seattle",
            "state": "WA",
            "postal_code": "981056367",
            "country_code": "US",
            "telephone_number": "206-616-4001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DUVALL",
        "first_name": "CHARLOTTE",
        "credential": "PA-S",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-08-16",
        "last_updated": "2024-05-13",
        "certification_date": "2024-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "PA61098760",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Federal Way, WA

Sources for this page

Verify at the official NPI Registry.