Individual provider Active NPI

Larissa Quadracci Mattei, PA-C

  • Surgical Physician Assistant
  • Issaquah, WA
National Provider Identifier
1033653142
Registry record updated May 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
PA60715586 Issued in WA
Practice address
510 8TH Ave NE Ste 200
Issaquah, WA 98029-5436
Phone
(253) 392-3030
Fax
(425) 392-2564
NPI assigned
Dec 7, 2016
Sex
Female
Sole proprietor
No

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA60715586 WA
Surgical Physician Assistant 363AS0400X PA60715586 WA Primary

Addresses

Primary practice location

510 8TH Ave NE Ste 200
Issaquah, WA 98029-5436

Mailing address

510 8TH Ave NE Ste 320
Issaquah, WA 98029-5436
Phone (253) 392-3030

Other practice location 1

18100 NE Union Hill Rd Ste 330
Redmond, WA 98052-3330
Phone (425) 455-3600

Other practice location 2

3101 Northup Way Ste 201
Bellevue, WA 98004-1449
Phone (425) 455-3600

Other practice location 3

515 Minor Ave Ste 200
Seattle, WA 98104-2133
Phone (425) 455-3600

Other identifiers 1

IdentifierTypeStateIssuer
2078341MedicaidWA

Other names 1

  • Larissa A Quadracci Former name

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
I20170123000932 WA Practitioner - Physician Assistant 6709168024 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Proliance Surgeons Inc P SGroup PAC ID 8527972900, 395 clinicians

Practice addresses (Care Compare)

3101 Northup Way
Bellevue, WA 98004-1449

510 8TH Ave NE
Issaquah, WA 98029-5436

Hospital & facility affiliations

  • Overlake Hospital Medical Center & Clinics Hospital, Bellevue, WA, CCN 500051

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA60715586WAMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
King County Public Hospital District No 2 CurrentSince Jan 4, 2017 Accepting new patients
King County Public Hospital District No. 2 CurrentSince Jan 4, 2017 Accepting new patients
Proliance Surgeons, Inc., P.S. CurrentSince May 15, 2023 Accepting new patients
Proliance Surgeons Inc P S Surgical CurrentSince May 15, 2023 Accepting new patients

Locations

3101 Northup Way
Ste 201
Bellevue, WA 98004
Phone (425) 455-3600

1909 214th St SE
Ste 110
Bothell, WA 98021
Phone (425) 488-4988

510 8th Ave NE
Ste 200
Issaquah, WA 98029
Phone (425) 392-3030

12039 NE 128th St
Ste 300
Kirkland, WA 98034
Phone (425) 899-3123

14841 179th Ave SE
Ste 330
Monroe, WA 98272
Phone (360) 794-3300

18100 NE Union Hill Rd
Ste 330
Redmond, WA 98052
Phone (425) 392-3030

515 Minor Ave
Ste 200
Seattle, WA 98104
Phone (206) 386-9615

805 Madison St
Ste 901
Seattle, WA 98104
Phone (206) 264-8100

Organizations & group practices 6

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.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1481068800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715558400000",
    "number": "1033653142",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "510 8TH AVE NE STE 320",
            "city": "ISSAQUAH",
            "state": "WA",
            "postal_code": "980295436",
            "telephone_number": "253-392-3030",
            "fax_number": "425-392-2564"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "510 8TH AVE NE STE 200",
            "city": "ISSAQUAH",
            "state": "WA",
            "postal_code": "980295436",
            "telephone_number": "253-392-3030",
            "fax_number": "425-392-2564"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "18100 NE Union Hill Rd Ste 330",
            "address_purpose": "LOCATION",
            "city": "Redmond",
            "state": "WA",
            "postal_code": "980523330",
            "country_code": "US",
            "telephone_number": "425-455-3600",
            "fax_number": "425-455-3920",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3101 Northup Way Ste 201",
            "address_purpose": "LOCATION",
            "city": "Bellevue",
            "state": "WA",
            "postal_code": "980041449",
            "country_code": "US",
            "telephone_number": "425-455-3600",
            "fax_number": "425-455-3920",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "515 Minor Ave Ste 200",
            "address_purpose": "LOCATION",
            "city": "Seattle",
            "state": "WA",
            "postal_code": "981042133",
            "country_code": "US",
            "telephone_number": "425-455-3600",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MATTEI",
        "first_name": "LARISSA",
        "middle_name": "QUADRACCI",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-12-07",
        "last_updated": "2024-05-13",
        "certification_date": "2024-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "WA",
            "license": "PA60715586",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "WA",
            "license": "PA60715586",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2078341",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LARISSA",
            "last_name": "QUADRACCI",
            "middle_name": "A",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Issaquah, WA

Sources for this page

Verify at the official NPI Registry.