NPIMap

Organization Active NPI

Pacific Rim Headache Center

  • Physician Assistant
  • Anacortes, WA
National Provider Identifier
1174822159
Registry record updated Mar 1, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
10004470 Issued in WA
Legal business name
PACIFIC RIM HEADACHE CENTER
Practice address
715 Seafarers Way
Ste 201 B
Anacortes, WA 98221-2257
Phone
(360) 588-1460
Fax
(360) 588-1473
NPI assigned
Mar 16, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 1, 2012

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

Authorized official

Name
Johnny Michael Jones, MPAS-CNPI 1174692198
Title
Owner
Phone
(360) 588-1460

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X 00009893 WA
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X 00017410 WA
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X 10004470 WA Primary

Addresses

Primary practice location

715 Seafarers Way
Ste 201 B
Anacortes, WA 98221-2257

Mailing address

715 Seafarers Way
Ste 201 B
Anacortes, WA 98221-2257
Phone (360) 588-1460

Other identifiers 1

IdentifierTypeStateIssuer
1174822159MedicaidWA

National Provider Directory

National Provider Directory

Locations

715 Seafarers Way
Ste 201B
Anacortes, WA 98221
Phone (360) 588-1460

3015 Squalicum Pkwy
Ste 180
Bellingham, WA 98225
Phone (360) 733-5733

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1300233600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1330560000000",
    "number": "1174822159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "715 SEAFARERS WAY",
            "address_2": "STE 201 B",
            "city": "ANACORTES",
            "state": "WA",
            "postal_code": "982212257",
            "telephone_number": "360-588-1460",
            "fax_number": "360-588-1473"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "715 SEAFARERS WAY",
            "address_2": "STE 201 B",
            "city": "ANACORTES",
            "state": "WA",
            "postal_code": "982212257",
            "telephone_number": "360-588-1460",
            "fax_number": "360-588-1473"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFIC RIM HEADACHE CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-03-16",
        "last_updated": "2012-03-01",
        "status": "A",
        "authorized_official_last_name": "JONES",
        "authorized_official_first_name": "JOHNNY",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "360-588-1460",
        "authorized_official_credential": "MPAS-C"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": "WA",
            "license": "00009893",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "00017410",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "10004470",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1174822159",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Anacortes, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.