Active NPI
Suzanne M. Miner, PAC
- Physician Assistant
- Issaquah, WA
National Provider Identifier
1124210612
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA10005212
- Practice address
- 450 NW Gilman Blvd
Suite 301a
Issaquah, WA 98027-2483 - Phone
- (425) 654-1275
- Fax
- (425) 654-0539
- NPI assigned
- Aug 17, 2007
- Last updated
- Aug 16, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA10005212 | WA | Primary |
Addresses
Primary practice location
450 NW Gilman Blvd
Suite 301a
Issaquah, WA 98027-2483
Mailing address
14239 W Bell Rd
Ste 101
Surprise, AZ 85374-2470
Phone (425) 654-1275
Other names 1
- Suzanne M. Humphryes
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6785 | AZ | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Silver Falls Dermatology, LLC | Past | Accepting new patients | |
| All Dermatology, Inc. | Past | Accepting new patients | |
| Brandith G Irwin MD PLLC | Past | Accepting new patients |
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Madison Skin and Laser Center
- Dermatology Physician
- Seattle, WA
- NPI 1699831032
-
dba Frontier Dermatology
- Ambulatory Surgical Clinic/Center
- Seattle, WA
- NPI 1417163635
-
- Dermatopathology Physician
- Phoenix, AZ
- NPI 1558525824
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1187308800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1502841600000",
"number": "1124210612",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14239 W BELL RD",
"address_2": "STE 101",
"city": "SURPRISE",
"state": "AZ",
"postal_code": "853742470",
"telephone_number": "425-654-1275",
"fax_number": "425-654-0539"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "450 NW GILMAN BLVD",
"address_2": "SUITE 301A",
"city": "ISSAQUAH",
"state": "WA",
"postal_code": "980272483",
"telephone_number": "425-654-1275",
"fax_number": "425-654-0539"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MINER",
"first_name": "SUZANNE",
"middle_name": "M.",
"credential": "PAC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-08-17",
"last_updated": "2017-08-16",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "WA",
"license": "PA10005212",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "SUZANNE",
"last_name": "HUMPHRYES",
"middle_name": "M.",
"credential": "PAC",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Issaquah, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.