Individual provider Active NPI

Otis Lawrence, PA-C

  • Medical Physician Assistant
  • Tacoma, WA
National Provider Identifier
1134540909
Registry record updated Dec 22, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
Practice address
608 E 62ND St
Tacoma, WA 98404-1935
Phone
(210) 793-0595
NPI assigned
Dec 22, 2013
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 22, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X TX Primary

Addresses

Primary practice location

608 E 62ND St
Tacoma, WA 98404-1935

Mailing address

608 E 62ND St
Tacoma, WA 98404-1935
Phone (210) 793-0595

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD, DC2 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
I20230203001080 MD Practitioner - Physician Assistant 3274905070 Reassigns benefits to 1 organization
I20231027000220 DC Practitioner - Physician Assistant 3274905070 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
American Current Care PAGroup PAC ID 9739260019, 545 clinicians

Practice addresses (Care Compare)

100 S Charles St
Suite 150 Concentra Urgent Care
Baltimore, MD 21201-2730
Phone (410) 752-3010

1419 Knecht Ave
Baltimore, MD 21227-1415
Phone (410) 247-9595

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
American Current Care PA CurrentSince Oct 20, 2023 Accepting new patients
American Current Care, PA. CurrentSince Oct 20, 2023 Accepting new patients
American Current Care P.a. CurrentSince Oct 20, 2023 Accepting new patients

Locations

1419 Knecht Ave
Halethorpe, MD 21227
Phone (410) 247-9595

4451 Parliament Pl
Ste G
Lanham, MD 20706
Phone (301) 459-9113

5080 Spectrum Dr
Ste 1200W
Addison, TX 75001

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1387670400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1387670400000",
    "number": "1134540909",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "608 E 62ND ST",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984041935",
            "telephone_number": "210-793-0595"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "608 E 62ND ST",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984041935",
            "telephone_number": "210-793-0595"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAWRENCE",
        "first_name": "OTIS",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-12-22",
        "last_updated": "2013-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "TX",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tacoma, WA

Sources for this page

Verify at the official NPI Registry.