Individual provider Active NPI

Mark W. Mashita, PA-C

  • Surgical Physician Assistant
  • Everett, WA
National Provider Identifier
1245412535
Registry record updated Apr 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
PA10005281 Issued in WA
Practice address
1100 Pacific Ave Ste 300
Everett, WA 98201-4261
Phone
(425) 339-2433
Fax
(425) 339-8273
NPI assigned
Nov 29, 2007
Last updated
Apr 15, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 15, 2024

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 PA10005281 WA
Surgical Physician Assistant 363AS0400X PA10005281 WA Primary

Addresses

Primary practice location

1100 Pacific Ave Ste 300
Everett, WA 98201-4261

Mailing address

1100 Pacific Ave Ste 300
Everett, WA 98201-4261
Phone (425) 339-2433

Other identifiers 1

IdentifierTypeStateIssuer
2012654MedicaidWA

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
I20071211000218 WA Practitioner - Physician Assistant 3779672902 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Proliance Surgeons Inc P SGroup PAC ID 8527972900, 395 clinicians

Practice addresses (Care Compare)

1100 Pacific Ave
Suite 300
Everett, WA 98201-4261
Phone (425) 339-2433

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PA10005281WAMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Proliance Surgeons Inc P S Surgical CurrentSince Oct 31, 2007 Accepting new patients
Proliance Surgeons, Inc., P.S. CurrentSince Oct 31, 2007 Accepting new patients

Locations

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

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

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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": "1196294400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713139200000",
    "number": "1245412535",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 PACIFIC AVE STE 300",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982014261",
            "telephone_number": "425-339-2433",
            "fax_number": "425-339-8273"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 PACIFIC AVE STE 300",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982014261",
            "telephone_number": "425-339-2433",
            "fax_number": "425-339-8273"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MASHITA",
        "first_name": "MARK",
        "middle_name": "W.",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-11-29",
        "last_updated": "2024-04-15",
        "certification_date": "2024-04-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "PA10005281",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "WA",
            "license": "PA10005281",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2012654",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Everett, WA

Sources for this page

Verify at the official NPI Registry.