Individual provider Active NPI

Lynda Jo Storm, PA-C

  • Medical Physician Assistant
  • Lynnwood, WA
National Provider Identifier
1245218429
Registry record updated Oct 23, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA10004574 Issued in WA
Practice address
19020 33Rd Ave W Ste 210
Lynnwood, WA 98036-4748
Phone
(425) 563-1500
Fax
(425) 563-1374
NPI assigned
Jan 6, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 23, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA10004574 WA Primary

Addresses

Primary practice location

19020 33Rd Ave W Ste 210
Lynnwood, WA 98036-4748

Mailing address

19020 33Rd Ave W Ste 210
Lynnwood, WA 98036-4748
Phone (425) 563-1500

Other identifiers 3

IdentifierTypeStateIssuer
180728OtherWAL&I PROVIDER NUMBER
178162OtherWAL&I PROVIDER NUMBER
8377517MedicaidWA

Other names 1

  • Lynda Golder Former name

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
I20040316000308 WA Practitioner - Physician Assistant 6800786856 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Radia Inc P SGroup PAC ID 9931012812, 275 clinicians

Practice addresses (Care Compare)

1321 Colby Ave
Everett, WA 98201-1665
Phone (425) 261-4100

500 17TH Ave
Seattle, WA 98122-5711
Phone (206) 320-3700

Hospital & facility affiliations

  • Providence Regional Medical Center Everett Hospital, Everett, WA, CCN 500014

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA10004574WAMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Proliance Surgeons Inc., P.S. CurrentSince Apr 18, 2022 Accepting new patients
Proliance Surgeons Inc P S CurrentSince Apr 18, 2022 Accepting new patients

Locations

1100 Pacific Ave
Ste 300
Everett, WA 98201
Phone (425) 337-7000

601 Broadway
Fl 6
Seattle, WA 98122
Phone (206) 633-8100

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

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.

Hospital & facility affiliations 2

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": "1136505600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1540252800000",
    "number": "1245218429",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19020 33RD AVE W STE 210",
            "city": "LYNNWOOD",
            "state": "WA",
            "postal_code": "980364748",
            "telephone_number": "425-563-1500",
            "fax_number": "425-563-1374"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19020 33RD AVE W STE 210",
            "city": "LYNNWOOD",
            "state": "WA",
            "postal_code": "980364748",
            "telephone_number": "425-563-1500",
            "fax_number": "425-563-1374"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STORM",
        "first_name": "LYNDA",
        "middle_name": "JO",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-06",
        "last_updated": "2018-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "WA",
            "license": "PA10004574",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "L&I PROVIDER NUMBER",
            "identifier": "180728",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "L&I PROVIDER NUMBER",
            "identifier": "178162",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8377517",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LYNDA",
            "last_name": "GOLDER",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Lynnwood, WA

Sources for this page

Verify at the official NPI Registry.