Active NPI
Brandi Jo Desaveur, PA-C
- Physician Assistant
- Spokane, WA
National Provider Identifier
1255411468
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA10005083
- Practice address
- 911 W. 5TH Ave.
Spokane, WA 99204 - Phone
- (509) 455-7844
- Fax
- (509) 623-0415
- NPI assigned
- Oct 16, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA10005083 | WA | Primary |
Addresses
Primary practice location
911 W. 5TH Ave.
Spokane, WA 99204
Mailing address
PO Box 8500 Lockbox 7642
Philadelphia, PA 19178-7642
Phone (813) 281-8115
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0234704 | Other | WA | L&I |
| P00613585 | Other | WA | RR MEDICARE |
| 80768780 | Other | WA | ID MEDICAID |
| 0234704 | Other | WA | CRIME VICTIMS |
| 8799DE | Other | WA | ASURIS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA10005083 | WA | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160956800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1534291200000",
"number": "1255411468",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 8500 LOCKBOX 7642",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191787642",
"telephone_number": "813-281-8115",
"fax_number": "813-281-8656"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "911 W. 5TH AVE.",
"city": "SPOKANE",
"state": "WA",
"postal_code": "99204",
"telephone_number": "509-455-7844",
"fax_number": "509-623-0415"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DESAVEUR",
"first_name": "BRANDI",
"middle_name": "JO",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-16",
"last_updated": "2018-08-15",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "WA",
"license": "PA10005083",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "L&I",
"identifier": "0234704",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE",
"identifier": "P00613585",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ID MEDICAID",
"identifier": "80768780",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CRIME VICTIMS",
"identifier": "0234704",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ASURIS",
"identifier": "8799DE",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Spokane, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.