Individual provider Active NPI

Kristen Erin Roberts, PA-C

  • Surgical Physician Assistant
  • Mount Vernon, WA
National Provider Identifier
1235694936
Registry record updated Mar 4, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
PA60917935 Issued in WA
Practice address
1500 Continental PL
Mount Vernon, WA 98273-4105
Phone
(360) 424-7041
Fax
(360) 424-2418
NPI assigned
Feb 6, 2019
Last updated
Mar 4, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 4, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X PA60917935 WA Primary

Addresses

Primary practice location

1500 Continental PL
Mount Vernon, WA 98273-4105

Mailing address

805 Madison St Ste 901
Seattle, WA 98104-1172
Phone (206) 838-2585

Other practice location 1

1017 20th St
Anacortes, WA 98221-2505
Phone (360) 424-7041

Other practice location 2

2720 Commercial Ave
Anacortes, WA 98221-2734
Phone (360) 424-7041

Other practice location 3

1401 S Laventure Rd
Mount Vernon, WA 98274-6033
Phone (360) 424-2400

Other identifiers 1

IdentifierTypeStateIssuer
2121972MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
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 1

Enrollment IDStateProvider typePAC IDDetails
I20190416000198 WA Practitioner - Physician Assistant 5395086607 Reassigns benefits to 3 organizations

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
Multicare Health SystemGroup PAC ID 7719899897, 2,312 clinicians

Practice addresses (Care Compare)

17700 SE 272ND St
Covington, WA 98042-4951
Phone (253) 372-7030

202 N Division St
Auburn, WA 98001-4939

222 State Ave N
Kent, WA 98030-4544
Phone (253) 372-7788

2720 Commercial Ave
Anacortes, WA 98221-2734
Phone (360) 299-1300

311 S L St
Tacoma, WA 98405-3720

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Multicare Health System CurrentSince Feb 1, 2021 Accepting new patients
Multicare Health System CurrentSince Feb 1, 2021 Accepting new patients
Public Hospital District No 2 Skagit County Washington CurrentSince Mar 1, 2026 Accepting new patients
Proliance Surgeons Inc P S Surgical CurrentSince Mar 4, 2019 Accepting new patients
Proliance Surgeons Inc P S Surgical CurrentSince Mar 4, 2019 Accepting new patients
Public Hospital District No 2 Skagit County Washington CurrentSince Mar 1, 2026 Accepting new patients
Multicare Health System Past Accepting new patients

Locations

1017 20th St
Anacortes, WA 98221
Phone (360) 424-7041

1211 24th St
Anacortes, WA 98221
Phone (360) 293-3181

2720 Commercial Ave
Anacortes, WA 98221
Phone (360) 299-1300

4700 Point Fosdick Dr
Ste 104
Gig Harbor, WA 98335
Phone (253) 459-7590

222 State Ave N
Kent, WA 98030
Phone (253) 372-7680

1500 Continental Pl
Mount Vernon, WA 98273
Phone (360) 424-7041

1401 S Laventure Rd
Mount Vernon, WA 98274
Phone (360) 424-2400

805 Madison St
Ste 901
Seattle, WA 98104
Phone (206) 264-8100

317 Martin Luther King Jr Way
Tacoma, WA 98405
Phone (253) 403-1400

316 S K St
Tacoma, WA 98405
Phone (253) 403-1375

3124 S 19th St
Ste 340
Tacoma, WA 98405
Phone (253) 459-7000

315 S K St
Tacoma, WA 98405
Phone (253) 403-1291

311 S L St
Tacoma, WA 98405
Phone (253) 403-1444

Interoperability endpoints

  • Direct secure messaging: kristen.roberts.p15@direct.proliance.nextgenshare.com
  • Direct secure messaging: kroberts563891@direct.multicare.org

Organizations & group practices 10

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 3

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": "1549411200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1551657600000",
    "number": "1235694936",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "805 MADISON ST STE 901",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981041172",
            "telephone_number": "206-838-2585"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 CONTINENTAL PL",
            "city": "MOUNT VERNON",
            "state": "WA",
            "postal_code": "982734105",
            "telephone_number": "360-424-7041",
            "fax_number": "360-424-2418"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1017 20th St",
            "address_purpose": "LOCATION",
            "city": "Anacortes",
            "state": "WA",
            "postal_code": "982212505",
            "country_code": "US",
            "telephone_number": "360-424-7041",
            "fax_number": "360-424-2418",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2720 Commercial Ave",
            "address_purpose": "LOCATION",
            "city": "Anacortes",
            "state": "WA",
            "postal_code": "982212734",
            "country_code": "US",
            "telephone_number": "360-424-7041",
            "fax_number": "360-424-2418",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1401 S Laventure Rd",
            "address_purpose": "LOCATION",
            "city": "Mount Vernon",
            "state": "WA",
            "postal_code": "982746033",
            "country_code": "US",
            "telephone_number": "360-424-2400",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROBERTS",
        "first_name": "KRISTEN",
        "middle_name": "ERIN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-02-06",
        "last_updated": "2019-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "WA",
            "license": "PA60917935",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2121972",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mount Vernon, WA

Sources for this page

Verify at the official NPI Registry.