NPIMap

Individual provider Active NPI

Jacqueline Hines-Kruse, PA-C

  • Physician Assistant
  • Ritzville, WA
National Provider Identifier
1316565708
Registry record updated Aug 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
210 W Main Ave
Ritzville, WA 99169-1410
Phone
(509) 659-4800
NPI assigned
Jul 11, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 9, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X PA61096605 WA
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

210 W Main Ave
Ritzville, WA 99169-1410

Mailing address

1506 W Highline LN
Spokane, WA 99201-1911
Phone (623) 308-4704

Other practice location 1

905 E D St
Deer Park, WA 99006-5167
Phone (509) 276-5005

Other names 1

  • Jacqueline Fernandez Other name

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
I20210331002257 WA Practitioner - Physician Assistant 7315353810 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Multicare Health SystemGroup PAC ID 7719899897, 2,312 clinicians

Practice addresses (Care Compare)

300 E 5TH Ave
Spokane, WA 99202-1334

311 S L St
Tacoma, WA 98405-3720

400 E 5TH Ave
Spokane, WA 99202-1334
Phone (509) 838-2531

4700 Point Fosdick Dr
Gig Harbor, WA 98335-1706

Hospital & facility affiliations

  • Deaconess Medical Center Hospital, Spokane, WA, CCN 500044
  • Tacoma General Allenmore Hospital Hospital, Tacoma, WA, CCN 500129

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Multicare Health System CurrentSince Oct 11, 2024 Accepting new patients
Multicare Health System CurrentSince Oct 11, 2024 Accepting new patients
Rockwood Clinic PS Family Medicine Past Accepting new patients
Multicare Health System Family Medicine Past Accepting new patients

Locations

4700 Point Fosdick Dr
Ste 104
Gig Harbor, WA 98335
Phone (253) 459-7590

210 W Main Ave
Ritzville, WA 99169
Phone (509) 659-4800

311 S L St
Tacoma, WA 98405
Phone (253) 403-1444

Interoperability endpoints

  • Direct secure messaging: jhineskruse806458@direct.multicare.org

Organizations & group practices 7

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": "1594425600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660003200000",
    "number": "1316565708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1506 W HIGHLINE LN",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992011911",
            "telephone_number": "623-308-4704"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 W MAIN AVE",
            "city": "RITZVILLE",
            "state": "WA",
            "postal_code": "991691410",
            "telephone_number": "509-659-4800"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "905 E D St",
            "address_purpose": "LOCATION",
            "city": "Deer Park",
            "state": "WA",
            "postal_code": "990065167",
            "country_code": "US",
            "telephone_number": "509-276-5005",
            "fax_number": "509-276-7785",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HINES-KRUSE",
        "first_name": "JACQUELINE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-07-11",
        "last_updated": "2022-08-09",
        "certification_date": "2022-08-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "PA61096605",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACQUELINE",
            "last_name": "FERNANDEZ",
            "credential": "PA-C",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Ritzville, WA

Sources for this page

Verify at the official NPI Registry.