Individual provider Active NPI

Jennipher Colas, PA-C

  • Physician Assistant
  • Moses Lake, WA
National Provider Identifier
1164036224
Registry record updated Sep 9, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA61098449 Issued in WA
Practice address
840 E Hill Ave
Moses Lake, WA 98837-2238
Phone
(509) 663-8711
NPI assigned
Sep 4, 2020
Last updated
Sep 9, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 9, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X
Physician Assistant 363A00000X PA61098449 WA Primary

Addresses

Primary practice location

840 E Hill Ave
Moses Lake, WA 98837-2238

Mailing address

820 N Chelan Ave
Wenatchee, WA 98801-2028
Phone (509) 663-8711

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200924003424 WA Practitioner - Physician Assistant 7214356278 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

605 S Coolidge St
Suite 101
Moses Lake, WA 98837-1893
Phone (509) 765-0674

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA61098449WAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Moses Lake Community Health Center CurrentSince Jul 17, 2023 Accepting new patients
Moses Lake Community Health Center Past Accepting new patients

Locations

605 S Coolidge St
Moses Lake, WA 98837
Phone (509) 765-0674

605 S Coolidge St
#101
Moses Lake, WA 98837
Phone (509) 765-0674

Organizations & group practices 2

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.

Hospital & facility affiliations 1

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": "1599177600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599609600000",
    "number": "1164036224",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "820 N CHELAN AVE",
            "city": "WENATCHEE",
            "state": "WA",
            "postal_code": "988012028",
            "telephone_number": "509-663-8711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "840 E HILL AVE",
            "city": "MOSES LAKE",
            "state": "WA",
            "postal_code": "988372238",
            "telephone_number": "509-663-8711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COLAS",
        "first_name": "JENNIPHER",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-09-04",
        "last_updated": "2020-09-09",
        "certification_date": "2020-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "PA61098449",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Moses Lake, WA

Sources for this page

Verify at the official NPI Registry.