Annie M Coronado, PA
Individual provider Active NPI Medical Physician Assistant · Othello, WA
NPI 1154757359 · NPPES record last updated Mar 24, 2021
Key facts
- NPI
- 1154757359
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Medical Physician Assistant 363AM0700X
- License
- PA60415801 (WA)
- Practice address
- 1515 E Columbia St
Othello, WA 99344-1846 - Phone
- (509) 488-5256
- Fax
- (509) 488-9939
- NPI assigned
- Sep 19, 2013
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 11
Hospital & facility affiliations 3
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- University of Washington School of Medicine, 2013
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Columbia Basin Health Association
Practice addresses (Care Compare)
1515 E Columbia St
Othello, WA 99344-1846
Phone 50948852568512
601 Government Way
Mattawa, WA 99349
Phone 50948852568512
Hospital & facility affiliations
- Othello Community Hospital
- Kadlec Regional Medical Center
- Samaritan Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20131125000772 | WA | Practitioner - Physician Assistant | 6901032895 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA60415801 | WA | MD | Medical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Columbia Basin Health Association | Current |
Accepting new patients | |
| Columbia Basin Health Association | Current |
Accepting new patients | |
| Columbia Basin Health Association | Past | Accepting new patients |
Locations
601 Government Rd
Mattawa, WA 99349
Phone 5094885256 ext. 8512
475 N 14th Ave
Othello, WA 99344
Phone (425) 823-4000
1515 E Columbia St
Othello, WA 99344
Phone (509) 488-5250
140 E Main St
Othello, WA 99344
Phone 50948852562034
7405 Three Rivers Dr
Pasco, WA 99301
Phone 5094885256 ext. 8512
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | PA60415801 | WA | Yes |
Addresses
Primary practice location
1515 E Columbia St
Othello, WA 99344-1846
Mailing address
1515 E Columbia St
Othello, WA 99344-1846
Phone (509) 488-5256
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2030781 | Medicaid | WA |
Other providers in Othello, WA
- Columbia Basin Health Association
- Columbia Basin Health Association
- Columbia Basin Health Association
- Columbia Basin Health Association
- Columbia Basin Health Association
- County of Adams
- County of Adams
- County of Adams
- Brent Darrington
- Patrice A Dial
All providers in Othello, WA · Medical Physician Assistant in Washington
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 24, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.