NPIMap

Individual provider Active NPI

Kyle Pine

  • Physician Assistant
  • Olympia, WA
National Provider Identifier
1225601669
Registry record updated Mar 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
1225601669 Issued in WA
Practice address
3901 Capital Mall Dr SW Ste a
Olympia, WA 98502-8654
Phone
(206) 616-4001
NPI assigned
Jul 22, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 20, 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 1225601669 WA Primary

Addresses

Primary practice location

3901 Capital Mall Dr SW Ste a
Olympia, WA 98502-8654

Mailing address

3901 Capital Mall Dr SW Ste a
Olympia, WA 98502-8654

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
I20221118001823 WA Practitioner - Physician Assistant 6608244892 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
University of Washington School of Medicine, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Olympia Orthopaedic Associates PLLCGroup PAC ID 2365337508, 87 clinicians

Practice addresses (Care Compare)

3901 Capital Mall Dr SW
Olympia, WA 98502-8654

3909 9TH Ave SW
Olympia, WA 98502-5134
Phone (360) 570-3460

615 Lilly Rd NE
Olympia, WA 98506-5117
Phone (360) 491-4211

Hospital & facility affiliations

  • Providence St Peter Hospital Hospital, Olympia, WA, CCN 500024
  • Mason General Hospital & Family of Clinics Hospital, Shelton, WA, CCN 501336
  • Summit Pacific Medical Center Hospital, Elma, WA, CCN 501304
  • Grays Harbor Community Hospital Hospital, Aberdeen, WA, CCN 500031
  • Capital Medical Center Hospital, Olympia, WA, CCN 500139

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1225601669WAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Olympia Orthopaedic Associates, PLLC CurrentSince Jan 1, 2023 Accepting new patients
Olympia Orthopaedic Associates PLLC CurrentSince Jan 1, 2023 Accepting new patients

Locations

3901 Capital Mall Dr SW
Ste B
Olympia, WA 98502
Phone (360) 528-8571

3901 Capital Mall Dr SW
#A
Olympia, WA 98502
Phone (360) 570-3460

3909 9th Ave SW
Olympia, WA 98502
Phone (360) 570-3460

615 Lilly Rd NE
Ste 240
Olympia, WA 98506
Phone (360) 413-3850

Interoperability endpoints

  • Direct secure messaging: kyle.pine.1@5512.direct.athenahealth.com
  • FHIR API: https://api.platform.athenahealth.com/5512/brand/1/csg/1/fhir/r4

Organizations & group practices 3

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 10

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": "1626912000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1679270400000",
    "number": "1225601669",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3901 CAPITAL MALL DR SW STE A",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985028654"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3901 CAPITAL MALL DR SW STE A",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985028654",
            "telephone_number": "206-616-4001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PINE",
        "first_name": "KYLE",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-07-22",
        "last_updated": "2023-03-20",
        "certification_date": "2023-03-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "1225601669",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Olympia, WA

Sources for this page

Verify at the official NPI Registry.