NPIMap

Individual provider Active NPI

Eyob G Kidane, PA-C

  • Physician Assistant
  • Pasco, WA
National Provider Identifier
1215349998
Registry record updated Aug 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
60564696 Issued in WA
Practice address
7425 Wrigley Dr
Ste 100
Pasco, WA 99301-5292
Phone
(509) 416-8888
Fax
(509) 545-6842
NPI assigned
May 29, 2014
Last updated
Aug 3, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 3, 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 51493 CA
Physician Assistant 363A00000X 60564696 WA Primary

Addresses

Primary practice location

7425 Wrigley Dr
Ste 100
Pasco, WA 99301-5292

Mailing address

520 N 4TH Ave
Pasco, WA 99301-5257
Phone (509) 416-8849

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150922001188 WA Practitioner - Physician Assistant 0446477087 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lourdes Hospital LLCGroup PAC ID 1850642562, shared by 5 NPIs, 42 clinicians

Practice addresses (Care Compare)

5304 N Rd
Suite 68
Pasco, WA 99301-8078
Phone (509) 543-9300

7425 Wrigley Dr
Pasco, WA 99301-5292

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
51493CAMDDentist
60564696WAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Lourdes Hospital LLC CurrentSince Sep 1, 2018 Accepting new patients
Lourdes Hospital LLC Current Accepting new patients
Our Lady of Lourdes Health Center Past Accepting new patients
Our Lady of Lourdes Health Center Past Accepting new patients
Our Lady of Lourdes Health Center Past Accepting new patients

Locations

1200 N 14th Ave
Pasco, WA 99301
Phone (509) 547-7536

520 N 4th Ave
Pasco, WA 99301
Phone (509) 544-6140

7425 Wrigley Dr
Ste 100
Pasco, WA 99301
Phone (509) 416-8888

7425 Wrigley Dr
Ste 204
Pasco, WA 99301
Phone (509) 416-0027

Interoperability endpoints

  • Direct secure messaging: eyob.kidane.1@18485.direct.athenahealth.com

Organizations & group practices 5

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 5

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": "1401321600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1596412800000",
    "number": "1215349998",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "520 N 4TH AVE",
            "city": "PASCO",
            "state": "WA",
            "postal_code": "993015257",
            "telephone_number": "509-416-8849",
            "fax_number": "509-542-3059"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7425 WRIGLEY DR",
            "address_2": "STE 100",
            "city": "PASCO",
            "state": "WA",
            "postal_code": "993015292",
            "telephone_number": "509-416-8888",
            "fax_number": "509-545-6842"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIDANE",
        "first_name": "EYOB",
        "middle_name": "G",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-05-29",
        "last_updated": "2020-08-03",
        "certification_date": "2020-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "51493",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "60564696",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pasco, WA

Sources for this page

Verify at the official NPI Registry.