Individual provider Active NPI

Gavin Dawson

  • Physician Assistant
  • Seattle, WA
National Provider Identifier
1073163986
Registry record updated Jan 26, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
Medex Northwest 4311 11TH Avenue NE
Seattle, WA 98105
Phone
(206) 616-4001
Fax
(206) 616-3889
NPI assigned
Sep 13, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 26, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

Medex Northwest 4311 11TH Avenue NE
Seattle, WA 98105

Mailing address

Medex Northwest 4311 11TH Avenue NE
Seattle, WA 98105

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20210223001327 CA Practitioner - Physician Assistant 3870908924 Reassigns benefits to 3 organizations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Lipov Medical Group of Ca PC CurrentSince Dec 8, 2025 Accepting new patients

Locations

12381 Wilshire Blvd
Ste 205
Los Angeles, CA 90025
Phone (213) 894-9696

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 3

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": "1568332800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611619200000",
    "number": "1073163986",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "MEDEX NORTHWEST 4311 11TH AVENUE NE",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "98105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "MEDEX NORTHWEST 4311 11TH AVENUE NE",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "98105",
            "telephone_number": "206-616-4001",
            "fax_number": "206-616-3889"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAWSON",
        "first_name": "GAVIN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-09-13",
        "last_updated": "2021-01-26",
        "certification_date": "2021-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Seattle, WA

Sources for this page

Verify at the official NPI Registry.