Individual provider Active NPI

Philip G Hujdic, PA-C

  • Surgical Physician Assistant
  • Renton, WA
National Provider Identifier
1346511631
Registry record updated Oct 11, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
PA61205356 Issued in WA
Practice address
4011 Talbot Rd S Ste 300
Renton, WA 98055-5791
Phone
(425) 656-5060
Fax
(425) 656-5047
NPI assigned
Jan 19, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 11, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X PA61205356 WA Primary

Addresses

Primary practice location

4011 Talbot Rd S Ste 300
Renton, WA 98055-5791

Mailing address

4011 Talbot Rd S Ste 300
Renton, WA 98055-5791
Phone (425) 656-5060

Other practice location 1

27005 168th Pl SE Ste 201
Covington, WA 98042-4902
Phone (253) 630-3660

Other practice location 2

150 Andover Park W
Tukwila, WA 98188-2801
Phone (425) 979-2663

Other practice location 3

24060 SE Kent Kangley Rd Ste D-100
Maple Valley, WA 98038-6851
Phone (425) 358-7708

Other practice location 4

1620 Lake Tapps Pkwy SE Ste 115
Auburn, WA 98092-8376
Phone (253) 246-2860

Other identifiers 1

IdentifierTypeStateIssuer
2186095MedicaidWA

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20210920001989 WA Practitioner - Physician Assistant 3072770452 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Proliance Surgeons Inc P SGroup PAC ID 8527972900, 395 clinicians

Practice addresses (Care Compare)

4011 Talbot Rd S
Suite 300
Renton, WA 98055-5791
Phone (206) 656-5060

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2696CTMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Proliance Surgeons Inc., P.S. Surgical Current Accepting new patients
Proliance Surgeons Inc P S Surgical CurrentSince Sep 14, 2021 Accepting new patients
Proliance Surgeons Inc P S Physician Assistant CurrentSince Sep 14, 2021 Accepting new patients
Connecticut Orthopaedic Specialists, PC Surgical Past Accepting new patients
Proliance Surgeons, Inc., P.S. Past Accepting new patients

Locations

1620 Lake Tapps Pkwy SE
Ste 115
Auburn, WA 98092
Phone (253) 246-2860

27005 168th Pl SE
#201
Covington, WA 98042
Phone (253) 630-3660

24060 SE Kent Kangley Rd
#D100
Maple Valley, WA 98038
Phone (425) 358-7708

4011 Talbot Rd S
Ste 300
Renton, WA 98055
Phone (206) 656-5060

3600 Lind Ave SW
Ste 170
Renton, WA 98057
Phone (425) 656-4260

805 Madison St
Ste 901
Seattle, WA 98104
Phone (206) 264-8100

150 Andover Park W
Tukwila, WA 98188
Phone (425) 979-2663

Interoperability endpoints

  • Direct secure messaging: philip.hujdic@xdr.hhchealthdirect.org

Organizations & group practices 6

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": "1326931200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633910400000",
    "number": "1346511631",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4011 TALBOT RD S STE 300",
            "city": "RENTON",
            "state": "WA",
            "postal_code": "980555791",
            "telephone_number": "425-656-5060",
            "fax_number": "425-656-5047"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4011 TALBOT RD S STE 300",
            "city": "RENTON",
            "state": "WA",
            "postal_code": "980555791",
            "telephone_number": "425-656-5060",
            "fax_number": "425-656-5047"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "27005 168th Pl SE Ste 201",
            "address_purpose": "LOCATION",
            "city": "Covington",
            "state": "WA",
            "postal_code": "980424902",
            "country_code": "US",
            "telephone_number": "253-630-3660",
            "fax_number": "253-631-1591",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "150 Andover Park W",
            "address_purpose": "LOCATION",
            "city": "Tukwila",
            "state": "WA",
            "postal_code": "981882801",
            "country_code": "US",
            "telephone_number": "425-979-2663",
            "fax_number": "425-524-4447",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "24060 SE Kent Kangley Rd Ste D-100",
            "address_purpose": "LOCATION",
            "city": "Maple Valley",
            "state": "WA",
            "postal_code": "980386851",
            "country_code": "US",
            "telephone_number": "425-358-7708",
            "fax_number": "425-656-5047",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1620 Lake Tapps Pkwy SE Ste 115",
            "address_purpose": "LOCATION",
            "city": "Auburn",
            "state": "WA",
            "postal_code": "980928376",
            "country_code": "US",
            "telephone_number": "253-246-2860",
            "fax_number": "253-246-2861",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HUJDIC",
        "first_name": "PHILIP",
        "middle_name": "G",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-01-19",
        "last_updated": "2021-10-11",
        "certification_date": "2021-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "WA",
            "license": "PA61205356",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2186095",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Renton, WA

Sources for this page

Verify at the official NPI Registry.