Individual provider Active NPI

Laniel A Cua, PA-C

  • Physician Assistant
  • Seattle, WA
National Provider Identifier
1205307451
Registry record updated Oct 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA60904497 Issued in WA
Practice address
310 15TH Ave E
Seattle, WA 98112-5103
Phone
(206) 326-3000
Fax
(877) 515-2975
NPI assigned
Dec 16, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 3, 2023

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 PA60904497 WA Primary

Addresses

Primary practice location

310 15TH Ave E
Seattle, WA 98112-5103

Mailing address

19221 36TH Ave W Ste 201
Lynnwood, WA 98036-5700
Phone (425) 774-9564

Other practice location 1

19221 36th Ave W Ste 201
Lynnwood, WA 98036-5700
Phone (425) 774-9564

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwa.kp.org:14430/Interconnect-CE-PRD/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ceq Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA, IL2 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
I20231017001326 WA Practitioner - Physician Assistant 8729433362 Reassigns benefits to 1 organization
I20250825003366 IL Practitioner - Physician Assistant 8729433362 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Physicians Immediate Care North Chicago LLCGroup PAC ID 8729064159, 256 clinicians

Practice addresses (Care Compare)

121 W N Ave
Chicago, IL 60610-1315
Phone (312) 643-5606

2077 N Clybourn Ave
Chicago, IL 60614-4003
Phone (773) 886-1500

3909 N Western Ave
Chicago, IL 60618-3741
Phone (773) 739-9200

4211 N Cicero Ave
Chicago, IL 60641-1651
Phone (773) 794-1000

5228 N Northwest Hwy
Chicago, IL 60630-4620
Phone (773) 770-4707

5961 N Lincoln Ave
Chicago, IL 60659-3758
Phone (312) 702-3923

600 W Adams St
Chicago, IL 60661-3604
Phone (312) 506-0900

6140 N Broadway St
Chicago, IL 60660-2538
Phone (773) 435-9028

811 S State St
Chicago, IL 60605-2225
Phone (312) 566-9510

825 S State St
Chicago, IL 60605-2225
Phone (312) 566-9510

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Kaiser Foundation Health Plan of Washington CurrentSince Sep 5, 2023 Accepting new patients
Kaiser Foundation Health Plan of Washington CurrentSince Sep 5, 2023 Accepting new patients

Locations

310 15th Ave E
Seattle, WA 98112
Phone (206) 326-3500

200 15th Ave E
Seattle, WA 98112
Phone (206) 326-4530

9505 S Steele St
Tacoma, WA 98444
Phone (253) 597-6800

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.

NPI Registry JSON

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

{
    "created_epoch": "1544918400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696291200000",
    "number": "1205307451",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19221 36TH AVE W STE 201",
            "city": "LYNNWOOD",
            "state": "WA",
            "postal_code": "980365700",
            "telephone_number": "425-774-9564"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 15TH AVE E",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981125103",
            "telephone_number": "206-326-3000",
            "fax_number": "877-515-2975"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "19221 36th Ave W Ste 201",
            "address_purpose": "LOCATION",
            "city": "Lynnwood",
            "state": "WA",
            "postal_code": "980365700",
            "country_code": "US",
            "telephone_number": "425-774-9564",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CUA",
        "first_name": "LANIEL",
        "middle_name": "A",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-12-16",
        "last_updated": "2023-10-03",
        "certification_date": "2023-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "PA60904497",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwa.kp.org:14430/Interconnect-CE-PRD/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ceq",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "310 15th Ave E",
            "city": "Seattle",
            "state": "WA",
            "country_code": "US",
            "postal_code": "981125103",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Seattle, WA

Sources for this page

Verify at the official NPI Registry.