Individual provider Active NPI

Mary-Colleen D. Zucconi, P.A.

  • Surgical Physician Assistant
  • Vancouver, WA
National Provider Identifier
1194969717
Registry record updated Aug 7, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
PA60404649 Issued in WA
Practice address
200 NE Mother Joseph PL Ste 110
Vancouver, WA 98664
Phone
(360) 254-6161
Fax
(360) 449-1146
NPI assigned
Apr 27, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 7, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X PA152984 OR
Surgical Physician Assistant 363AS0400X PA60404649 WA Primary

Addresses

Primary practice location

200 NE Mother Joseph PL Ste 110
Vancouver, WA 98664

Mailing address

200 NE Mother Joseph PL Ste 210
Vancouver, WA 98664-3295
Phone (360) 254-6161

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR, WA2 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
I20110303000501 OR Practitioner - Physician Assistant 6800078452 Reassigns benefits to 1 organization
I20131107001576 WA Practitioner - Physician Assistant 6800078452 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Northwest Surgical Specialists PCGroup PAC ID 4183527153, 118 clinicians

Practice addresses (Care Compare)

1 N Ctr Court St
110 Rebound Sports Medicine
Portland, OR 97227-2104
Phone (503) 732-6863

200 NE Mother Joseph PL
Vancouver, WA 98664-3296
Phone (360) 254-6161

200 NE Mother Joseph PL
110 Rebound Orthopedics
Vancouver, WA 98664-3293
Phone (360) 254-6161

200 NE Mother Joseph PL
Suite 210
Vancouver, WA 98664-3295

2121 NE 139TH St
300 Rebound
Vancouver, WA 98686-2316
Phone (360) 254-6161

2211 NE 139TH St
Legacy Salmon Creek Medical Center
Vancouver, WA 98686-2742
Phone (360) 487-1000

400 NE Mother Joseph PL
Peacehealth Southwest Medical Center
Vancouver, WA 98664-3200
Phone (360) 514-2000

4811 Meadows Rd
Suite 101
Lake Oswego, OR 97035-2542
Phone (503) 635-2323

Hospital & facility affiliations

  • Peacehealth Southwest Medical Cente Hospital, Vancouver, WA, CCN 500050

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA152984ORMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Northwest Surgical Specialists PC CurrentSince Oct 7, 2013 Accepting new patients
Northwest Surgical Specialists, P.C. CurrentSince Oct 7, 2013 Accepting new patients
Pacific Surgical PC Past Accepting new patients
J and D Physical Therapy Services Past Accepting new patients

Locations

1 N Center Court St
Ste 11
Portland, OR 97227
Phone (503) 732-6863

200 NE Mother Joseph Pl
Ste 305
Vancouver, WA 98664

200 NE Mother Joseph Pl
Vancouver, WA 98664
Phone (360) 514-2990

3205 SE 192nd Ave
Ste 105
Vancouver, WA 98683

2121 NE 139th St
Ste 300
Vancouver, WA 98686

200 NE Mother Joseph Pl
Ste 210
Vancouver, WA 98664
Phone (360) 449-1145

200 NE Mother Joseph Pl
Ste 110
Vancouver, WA 98664
Phone (360) 256-8584

Interoperability endpoints

  • Direct secure messaging: marycolleen.zucconipac.p1@direct.reboundmd.nextgenshare.com
  • Direct secure messaging: mzucconi21947@reboundmd.gardenplot.direct-ci.com

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.

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": "1240790400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1533600000000",
    "number": "1194969717",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 NE MOTHER JOSEPH PL STE 210",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986643295",
            "telephone_number": "360-254-6161"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 NE MOTHER JOSEPH PL STE 110",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "98664",
            "telephone_number": "360-254-6161",
            "fax_number": "360-449-1146"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ZUCCONI",
        "first_name": "MARY-COLLEEN",
        "middle_name": "D.",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-04-27",
        "last_updated": "2018-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "OR",
            "license": "PA152984",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "WA",
            "license": "PA60404649",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vancouver, WA

Sources for this page

Verify at the official NPI Registry.