Trista Lee Pendergrast, ARNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

AP60330625 Issued in WA

Practice address

1400 E Kincaid St
Mount Vernon, WA 98274-4127

Phone

(360) 428-2501

Fax

(360) 428-2596

NPI assigned

Jan 17, 2013

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Trista Lee Pulley Former name

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

Specialty

Nurse Practitioner

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Public Hospital Dist No 1 SkagitGroup PAC ID 6800793522, 321 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Skagit Valley Hospital Hospital, Mount Vernon, WA, CCN 500003
• Whidbeyhealth Medical Center Hospital, Coupeville, WA, CCN 501339

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: tpendergrast15119@skagit.direct-ci.com

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.

• Public Hospital Dist No 1 Skagit

  • General Practice Physician
  • Mount Vernon, WA
  • NPI 1023332749
  Medicare reassignment Care Compare group NPD
• Public Hospital Dist No 1 Skagit

  • Primary Care Clinic/Center
  • Granite Falls, WA
  • NPI 1033164470
  NPD
• Public Hospital Dist No 1 Skagit

  • Physical Therapist
  • Mount Vernon, WA
  • NPI 1811460652
  NPD
• Public Hospital Dist No 1 Skagit

  • Specialist
  • Mount Vernon, WA
  • NPI 1629012463
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Public Hospital Dist No 1 Skagit

  • General Acute Care Hospital
  • Mount Vernon, WA
  • NPI 1053357244
  Care Compare affiliation
• Whidbey Island Public Hospital District

  • Critical Access Hospital
  • Oak Harbor, WA
  • NPI 1144348228
  Care Compare affiliation
• Whidbey Island Public Hospital District

  • Critical Access Hospital
  • Coupeville, WA
  • NPI 1164549549
  Care Compare affiliation
• Whidbey Island Public Hospital District

  • Critical Access Hospital
  • Coupeville, WA
  • NPI 1497640445
  Care Compare affiliation
• Whidbey Island Public Hospital District

  • Critical Access Hospital
  • Coupeville, WA
  • NPI 1710927231
  Care Compare affiliation
• Whidbey Island Public Hospital District

  • Critical Access Hospital
  • Coupeville, WA
  • NPI 1902771728
  Care Compare affiliation
• Whidbey Island Public Hospital District

  • Critical Access Hospital
  • Clinton, WA
  • NPI 1992823595
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1358380800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1366070400000",
    "number": "1306184874",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 E KINCAID ST",
            "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": "1400 E KINCAID ST",
            "city": "MOUNT VERNON",
            "state": "WA",
            "postal_code": "982744127",
            "telephone_number": "360-428-2501",
            "fax_number": "360-428-2596"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENDERGRAST",
        "first_name": "TRISTA",
        "middle_name": "LEE",
        "name_prefix": "Mrs.",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-01-17",
        "last_updated": "2013-04-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WA",
            "license": "AP60330625",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TRISTA",
            "last_name": "PULLEY",
            "middle_name": "LEE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Michael A Payne, ARNP
• Anisa S. Pea, DPM
• Marta Varee Pearson
• Robert Wayne Peck, LPN
• Karen Joy Pederson, PT
• Aparna Pendurthi, M.D.
• Penelope Leggott DDS, Ms
• Amy Pereira, LICSW
• Performance Modalities Inc
• Blake J Perry, DDS

• Family Nurse Practitioner in Mount Vernon, WA
• Providers in Mount Vernon, WA by specialty
• Family Nurse Practitioner in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.