Individual provider Active NPI

Alma Jimenez, PA-C

  • Physician Assistant
  • Seattle, WA
National Provider Identifier
1336541580
Registry record updated Aug 20, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA12923 Issued in TX
Practice address
4311 11TH Ave NE Ste 200
Seattle, WA 98105-6367
Phone
(206) 616-4001
NPI assigned
Sep 18, 2014
Last updated
Aug 20, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2020

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 PA12923 TX Primary
Physician Assistant 363A00000X 60612801 WA

Addresses

Primary practice location

4311 11TH Ave NE Ste 200
Seattle, WA 98105-6367

Mailing address

4311 11TH Ave NE Ste 200
Seattle, WA 98105-6367
Phone (206) 616-4001

Other identifiers 1

IdentifierTypeStateIssuer
1336541580MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20200402001485 TX Practitioner - Physician Assistant 2264732254 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA12923TXMDPhysician Assistant
60612801WAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Goodside Health Medical, PLLC Physician Assistant Past Accepting new patients
Peter E. Logerfo, MD, PLLC Past Accepting new patients

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1410998400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597881600000",
    "number": "1336541580",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4311 11TH AVE NE STE 200",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981056367",
            "telephone_number": "206-616-4001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4311 11TH AVE NE STE 200",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981056367",
            "telephone_number": "206-616-4001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JIMENEZ",
        "first_name": "ALMA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-09-18",
        "last_updated": "2020-08-20",
        "certification_date": "2020-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA12923",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "60612801",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1336541580",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Seattle, WA

Sources for this page

Verify at the official NPI Registry.