Individual provider Active NPI

Jamie R Antoine, MD

  • Orthopaedic Surgery Physician
  • Kirkland, WA
National Provider Identifier
1114022969
Registry record updated Mar 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License
MD60007110 Issued in WA
Practice address
12911 120TH Ave NE Ste H210
Kirkland, WA 98034
Phone
(425) 823-4000
Fax
(425) 821-3550
NPI assigned
Sep 14, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 23, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Orthopaedic Surgery) Physician 207XX0005X MD60007110 WA
Orthopaedic Surgery Physician 207X00000X MD60007110 WA Primary

Addresses

Primary practice location

12911 120TH Ave NE Ste H210
Kirkland, WA 98034

Mailing address

12911 120TH Ave NE Ste G10
Kirkland, WA 98034-3048
Phone (425) 823-4000

Other identifiers 1

IdentifierTypeStateIssuer
1090846MedicaidWA

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090127000304 WA Practitioner - Orthopedic SurgeryPractitioner - Sports Medicine 1557425170 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic SurgeryAlso: Sports Medicine
Education
Albany Medical College of Union University, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Proliance Surgeons Inc P SGroup PAC ID 8527972900, 395 clinicians

Practice addresses (Care Compare)

12911 120TH Ave NE
Suite H120
Kirkland, WA 98034-3062
Phone (425) 823-4226

12911 120TH Ave NE
Suite H210
Kirkland, WA 98034-3065
Phone (425) 823-4000

Hospital & facility affiliations

  • Evergreenhealth Home Care Services Home health agency, Kirkland, WA, CCN 507079
  • Evergreenhealth Medical Center Hospital, Kirkland, WA, CCN 500124

Procedures performed for Medicare patients

ProcedureNumber of procedures
Knee replacement1-10
Lower limb (leg) arthroscopy (minimally invasive joint repair)1-10
Upper limb (arm) arthroscopy (minimally invasive joint repair)1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD60007110WAMDSports Medicine (Orthopaedic Surgery) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Proliance Surgeons Inc P S Orthopaedic Surgery CurrentSince Oct 1, 2018 Accepting new patients
Proliance Surgeons Inc P S Orthopaedic Surgery CurrentSince Oct 1, 2018 Accepting new patients
Proliance Surgeons Inc P S Orthopaedic Surgery Current Accepting new patients
Proliance Surgeons, Inc., P.S. Past Accepting new patients

Locations

12911 120th Ave NE
Ste G10
Kirkland, WA 98034
Phone (425) 481-6301

12911 120th Ave NE
Ste H120
Kirkland, WA 98034
Phone (425) 823-4226

12911 120th Ave NE
Ste H210
Kirkland, WA 98034
Phone (425) 823-4000

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

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.

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": "1158192000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1647993600000",
    "number": "1114022969",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12911 120TH AVE NE STE G10",
            "city": "KIRKLAND",
            "state": "WA",
            "postal_code": "980343048",
            "telephone_number": "425-823-4000",
            "fax_number": "425-821-3550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12911 120TH AVE NE STE H210",
            "city": "KIRKLAND",
            "state": "WA",
            "postal_code": "98034",
            "telephone_number": "425-823-4000",
            "fax_number": "425-821-3550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANTOINE",
        "first_name": "JAMIE",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-14",
        "last_updated": "2022-03-23",
        "certification_date": "2022-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207XX0005X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": "WA",
            "license": "MD60007110",
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "WA",
            "license": "MD60007110",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1090846",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kirkland, WA

Sources for this page

Verify at the official NPI Registry.