NPIMap

Individual provider Active NPI

Jeffrey D.T. Carroll, PAC

  • Medical Physician Assistant
  • Mount Vernon, WA
National Provider Identifier
1285169698
Registry record updated Mar 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA60794256 Issued in WA
Practice address
307 S 13TH St Ste 300
Mount Vernon, WA 98274-4100
Phone
(360) 336-9757
Fax
(360) 814-5237
NPI assigned
Apr 23, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2018

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 PA60794256 WA
Medical Physician Assistant 363AM0700X PA60794256 WA Primary

Addresses

Primary practice location

307 S 13TH St Ste 300
Mount Vernon, WA 98274-4100

Mailing address

1400 E. Kincaid Street
Attn: Credentialing
Mount Vernon, WA 98274-4127
Phone (360) 428-2500

Other practice location 1

3823 172nd St NE
Arlington, WA 98223-7735
Phone (360) 618-5000

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
I20171025003361 WA Practitioner - Physician Assistant 2163798711 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Whidbey Island Public Hospital DistrictGroup PAC ID 1658280680, 100 clinicians

Practice addresses (Care Compare)

11245 State Route 525
Clinton, WA 98236-8638
Phone (360) 341-5252

1300 NE Goldie St
Oak Harbor, WA 98277-4832

77 N Main St
Coupeville, WA 98239-9556
Phone (360) 682-2814

Hospital & facility affiliations

  • Whidbeyhealth Medical Center Hospital, Coupeville, WA, CCN 501339

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA60794256WAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Public Hospital District No 2 Skagit County Washington CurrentSince Jul 1, 2018 Accepting new patients
Public Hospital District No 2 Skagit County Washington CurrentSince Jul 1, 2018 Accepting new patients
WGH Primary Care Associates, P.S. Current Accepting new patients
Public Hospital Dist No 1 Skagit CurrentSince Oct 6, 2017 Accepting new patients
Whidbey Island Public Hospital District CurrentSince Nov 1, 2021 Accepting new patients
Whidbey Island Public Hospital District CurrentSince Nov 1, 2021 Accepting new patients

Locations

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

2511 M Ave
Ste B
Anacortes, WA 98221
Phone (360) 293-3101

3823 172nd St NE
Arlington, WA 98223
Phone (360) 618-5000

11245 State Route 525
Clinton, WA 98236
Phone (360) 341-5252

101 N Main St
Coupeville, WA 98239
Phone (360) 678-7656

1400 E Kincaid St
Mount Vernon, WA 98274
Phone (360) 428-2586

307 S 13th St
Ste 300
Mount Vernon, WA 98274
Phone (360) 336-9757

1300 NE Goldie St
Oak Harbor, WA 98277
Phone (360) 240-4070

275 SE Cabot Dr
Ste B101
Oak Harbor, WA 98277
Phone (360) 675-6648

Organizations & group practices 12

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 6

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": "1492905600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1285169698",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 E. KINCAID STREET",
            "address_2": "ATTN: CREDENTIALING",
            "city": "MOUNT VERNON",
            "state": "WA",
            "postal_code": "982744127",
            "telephone_number": "360-428-2500",
            "fax_number": "360-428-6485"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "307 S 13TH ST STE 300",
            "city": "MOUNT VERNON",
            "state": "WA",
            "postal_code": "982744100",
            "telephone_number": "360-336-9757",
            "fax_number": "360-814-5237"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3823 172nd St NE",
            "address_purpose": "LOCATION",
            "city": "Arlington",
            "state": "WA",
            "postal_code": "982237735",
            "country_code": "US",
            "telephone_number": "360-618-5000",
            "fax_number": "360-657-8750",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CARROLL",
        "first_name": "JEFFREY",
        "middle_name": "D.T.",
        "name_prefix": "Mr.",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-04-23",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "PA60794256",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "WA",
            "license": "PA60794256",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mount Vernon, WA

Sources for this page

Verify at the official NPI Registry.