Active NPI
Sydney Fountain, PA-C
- Physician Assistant
- Centralia, WA
National Provider Identifier
1356050744
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA61514013
- Practice address
- 1000 S Scheuber Rd
Centralia, WA 98531-8877 - Phone
- (360) 330-8950
- Fax
- (360) 330-8955
- NPI assigned
- Nov 15, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA61514013 | WA | Primary |
Addresses
Primary practice location
1000 S Scheuber Rd
Centralia, WA 98531-8877
Mailing address
PO Box 3360
Portland, OR 97208-3360
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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2022
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
1000 S Scheuber Rd
Centralia, WA 98531-8877
Phone (360) 330-8950
525 Lilly Rd NE
Olympia, WA 98506-5101
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA61514013 | WA | MD | Physician Assistant |
Interoperability endpoints
- sfountain3191494@wm.providencedirect.org
Organizations & group practices 1
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.
-
- Family Medicine Physician
- Olympia, WA
- NPI 1174744304
Hospital & facility affiliations 1
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Centralia, WA
- NPI 1376624981
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1668470400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1712102400000",
"number": "1356050744",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 3360",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972083360"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1000 S SCHEUBER RD",
"city": "CENTRALIA",
"state": "WA",
"postal_code": "985318877",
"telephone_number": "360-330-8950",
"fax_number": "360-330-8955"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FOUNTAIN",
"first_name": "SYDNEY",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-11-15",
"last_updated": "2024-04-03",
"certification_date": "2024-04-03",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "WA",
"license": "PA61514013",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Centralia, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2024; 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.