NPIMap

Individual provider Active NPI

Michael Thomas Prentice, PA-C

  • Physician Assistant
  • Pleasanton, CA
National Provider Identifier
1144622937
Registry record updated Sep 23, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA60497457 Issued in WA
Practice address
5000 Hopyard Rd Ste 100
Pleasanton, CA 94588-3146
Phone
(925) 924-1600
Fax
(925) 924-0506
NPI assigned
Sep 23, 2014
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 23, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA60497457 WA Primary

Addresses

Primary practice location

5000 Hopyard Rd Ste 100
Pleasanton, CA 94588-3146

Mailing address

5000 Hopyard Rd Ste 100
Pleasanton, CA 94588-3146
Phone (925) 924-1600

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
I20141121001491 WA Practitioner - Physician Assistant 7517289804 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Multicare Health SystemGroup PAC ID 7719899897, 2,312 clinicians

Practice addresses (Care Compare)

300 E 5TH Ave
Spokane, WA 99202-1334

311 S L St
Tacoma, WA 98405-3720

400 E 5TH Ave
Spokane, WA 99202-1334
Phone (509) 838-2531

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

State licenses

LicenseStateTypeSpecialty
PA60497457WAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Multicare Health System CurrentSince Sep 23, 2019 Accepting new patients
Multicare Health System CurrentSince Sep 23, 2019 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

16201 E Indiana Ave
Ste 5300
Spokane Valley, WA 99216
Phone (509) 465-8885

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

Interoperability endpoints

  • Direct secure messaging: mprentice351208@direct.multicare.org

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 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": "1411430400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1411430400000",
    "number": "1144622937",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5000 HOPYARD RD STE 100",
            "city": "PLEASANTON",
            "state": "CA",
            "postal_code": "945883146",
            "telephone_number": "925-924-1600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5000 HOPYARD RD STE 100",
            "city": "PLEASANTON",
            "state": "CA",
            "postal_code": "945883146",
            "telephone_number": "925-924-1600",
            "fax_number": "925-924-0506"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRENTICE",
        "first_name": "MICHAEL",
        "middle_name": "THOMAS",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-09-23",
        "last_updated": "2014-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "PA60497457",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pleasanton, CA

Sources for this page

Verify at the official NPI Registry.