NPIMap

Individual provider Active NPI

Kendahl Ann Ludiker, PA

  • Physician Assistant
  • Deer Park, WA
National Provider Identifier
1083248686
Registry record updated Aug 16, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA61212113 Issued in WA
Practice address
905 E D St
Deer Park, WA 99006-5167
Phone
(509) 276-5005
NPI assigned
Feb 24, 2020
Last updated
Aug 16, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 16, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA-2200 ID
Physician Assistant 363A00000X PA61212113 WA Primary

Addresses

Primary practice location

905 E D St
Deer Park, WA 99006-5167

Mailing address

PO Box 1529
Deer Park, WA 99006-1529
Phone (509) 276-5005

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220617000657 WA Practitioner - Physician Assistant 0244622363 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Multicare Health SystemGroup PAC ID 7719899897, 2,312 clinicians

Practice addresses (Care Compare)

311 S L St
Tacoma, WA 98405-3720

4700 Point Fosdick Dr
Gig Harbor, WA 98335-1706

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Multicare Health System Physician Assistant CurrentSince Jun 28, 2024 Accepting new patients
Multicare Health System CurrentSince Jun 28, 2024 Accepting new patients
Multicare Health System Physician Assistant Past Accepting new patients

Locations

4700 Point Fosdick Dr
Ste 104
Gig Harbor, WA 98335
Phone (253) 459-7590

311 S L St
Tacoma, WA 98405
Phone (253) 403-1444

Organizations & group practices 5

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.

Hospital & facility affiliations 4

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": "1582502400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660608000000",
    "number": "1083248686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1529",
            "city": "DEER PARK",
            "state": "WA",
            "postal_code": "990061529",
            "telephone_number": "509-276-5005",
            "fax_number": "844-807-3782"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "905 E D ST",
            "city": "DEER PARK",
            "state": "WA",
            "postal_code": "990065167",
            "telephone_number": "509-276-5005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LUDIKER",
        "first_name": "KENDAHL",
        "middle_name": "ANN",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-02-24",
        "last_updated": "2022-08-16",
        "certification_date": "2022-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ID",
            "license": "PA-2200",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "PA61212113",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Deer Park, WA

Sources for this page

Verify at the official NPI Registry.