NPIMap

Individual provider Active NPI

Keith P. Erickson, PA-C

  • Physician Assistant
  • Marysville, WA
National Provider Identifier
1225009061
Registry record updated May 18, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
11603 State Ave
Suite G
Marysville, WA 98271-8465
Phone
(360) 653-6500
NPI assigned
Jan 30, 2006
Last updated
May 18, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 18, 2021

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 3034 AZ
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

11603 State Ave
Suite G
Marysville, WA 98271-8465

Mailing address

PO Box 3360
Portland, OR 97208-3360

Other identifiers 1

IdentifierTypeStateIssuer
263798OtherWALABOR & INDUSTRIES

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kerickson746046@wm.providencedirect.org Direct

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
I20080304000611 WA Practitioner - Physician Assistant 3678542404 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

11603 State Ave
Suite G
Marysville, WA 98271-8465
Phone (360) 658-6800

12800 Bothell Everett Hwy
Everett, WA 98208-6642

4112 Harbour Pointe Blvd SW
Suite 100
Mukilteo, WA 98275-5457
Phone (425) 347-6330

7209 265TH St NW
Suite 203
Stanwood, WA 98292-6292
Phone (360) 658-6800

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
3034AZMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Public Hospital Dist No 1 Skagit CurrentSince Jul 1, 2010 Accepting new patients
Providence Health & Services- Washington CurrentSince Nov 1, 2016 Accepting new patients
Providence Health & Services - Washington CurrentSince Nov 1, 2016 Accepting new patients
Bellingham Internal Medicine Associates, PC Past Accepting new patients
Arizona Medical Services, PC PastSince Apr 28, 2005 Accepting new patients
Andris Radvany MD Inc Past Accepting new patients
Greater Phoenix Collaborative Care PC Past Accepting new patients
Greater Phoenix Collaborative Care PC Past Accepting new patients

Locations

1321 Colby Ave
Everett, WA 98201
Phone (425) 259-4413

11603 State Ave
Ste G
Marysville, WA 98271
Phone (360) 658-6800

1400 E Kincaid St
Mount Vernon, WA 98274
Phone (360) 428-2586

4112 Harbour Pointe Blvd SW
Ste 100
Mukilteo, WA 98275
Phone (425) 347-6330

Interoperability endpoints

  • Direct secure messaging: kerickson746046@wm.providencedirect.org

Organizations & group practices 9

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 4

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": "1138579200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621296000000",
    "number": "1225009061",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3360",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972083360"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11603 STATE AVE",
            "address_2": "SUITE G",
            "city": "MARYSVILLE",
            "state": "WA",
            "postal_code": "982718465",
            "telephone_number": "360-653-6500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ERICKSON",
        "first_name": "KEITH",
        "middle_name": "P.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-30",
        "last_updated": "2021-05-18",
        "certification_date": "2021-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "3034",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LABOR & INDUSTRIES",
            "identifier": "263798",
            "state": "WA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kerickson746046@wm.providencedirect.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "11603 State Ave",
            "address_2": "Suite G",
            "city": "Marysville",
            "state": "WA",
            "country_code": "US",
            "postal_code": "982718465",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Marysville, WA

Sources for this page

Verify at the official NPI Registry.