Individual provider Active NPI

Emily Jean Oliver, PA-C

  • Surgical Physician Assistant
  • Mount Vernon, WA
National Provider Identifier
1093298051
Registry record updated May 25, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
PA60868442 Issued in WA
Practice address
1400 E Kincaid St
Mount Vernon, WA 98274-4127
Phone
(360) 814-6113
Fax
(360) 814-6111
NPI assigned
Sep 14, 2018
Last updated
May 25, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 25, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA60868442 WA
Medical Physician Assistant 363AM0700X NU
Surgical Physician Assistant 363AS0400X PA60868442 WA Primary

Addresses

Primary practice location

1400 E Kincaid St
Mount Vernon, WA 98274-4127

Mailing address

1400 E Kincaid Street
Attn: Credentialing
Mount Vernon, WA 98274-4127
Phone (360) 428-2500

Other identifiers 1

IdentifierTypeStateIssuer
2112649MedicaidWA

Other names 1

  • Emily Jean Jette Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address ejette26901@skagit.direct-ci.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA, MA2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20190305000533 WA Practitioner - Physician Assistant 7911246228 Reassigns benefits to 2 organizations
I20250210000440 MA Practitioner - Physician Assistant 7911246228 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Boston University School of Medicine, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

103 Garland St
Everett, MA 02149-5066
Phone (617) 389-6270

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA60868442WAMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Seattle Children's Hospital CurrentSince Jun 16, 2023 Accepting new patients
Public Hospital Dist No 1 Skagit CurrentSince Dec 7, 2018 Accepting new patients
Seattle Childrens Hospital CurrentSince Jun 16, 2023 Accepting new patients
Cambridge Public Health Commission CurrentSince Oct 8, 2024 Accepting new patients
Cambridge Public Health Commission CurrentSince Oct 8, 2024 Accepting new patients

Locations

1493 Cambridge St
Cambridge, MA 02139
Phone (617) 665-1185

103 Garland St
Everett, MA 02149
Phone (617) 381-7150

1035 116th Ave NE
Bellevue, WA 98004
Phone (425) 451-4141

8232 W Grandridge Blvd
Kennewick, WA 99336
Phone (509) 582-1700

1400 E Kincaid St
Mount Vernon, WA 98274
Phone (360) 428-2586

1780 NW Myhre Rd
Ste 2120
Silverdale, WA 98383
Phone (360) 782-3100

Interoperability endpoints

  • Direct secure messaging: eoliver122146@direct.challiance.masshiway.net

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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": "1536883200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684972800000",
    "number": "1093298051",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 E KINCAID STREET",
            "address_2": "ATTN: CREDENTIALING",
            "city": "MOUNT VERNON",
            "state": "WA",
            "postal_code": "982744127",
            "telephone_number": "360-428-2500",
            "fax_number": "360-428-6485"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 E KINCAID ST",
            "city": "MOUNT VERNON",
            "state": "WA",
            "postal_code": "982744127",
            "telephone_number": "360-814-6113",
            "fax_number": "360-814-6111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OLIVER",
        "first_name": "EMILY",
        "middle_name": "JEAN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-09-14",
        "last_updated": "2023-05-25",
        "certification_date": "2023-05-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "PA60868442",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "WA",
            "license": "PA60868442",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2112649",
            "state": "WA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ejette26901@skagit.direct-ci.com",
            "affiliation": "N",
            "endpointDescription": "Provider Direct Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1400 E Kincaid St",
            "city": "Mount Vernon",
            "state": "WA",
            "country_code": "US",
            "postal_code": "982744127",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "EMILY",
            "last_name": "JETTE",
            "middle_name": "JEAN",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Mount Vernon, WA

Sources for this page

Verify at the official NPI Registry.