NPIMap

Individual provider Active NPI

Theresa A Jovanovich, PAC

  • Surgical Physician Assistant
  • Federal Way, WA
National Provider Identifier
1356490486
Registry record updated Dec 31, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
PA10004066 Issued in WA
Practice address
33501 1St Way S
Federal Way, WA 98003-6208
Phone
(253) 838-2400
Fax
(253) 874-1634
NPI assigned
Jan 9, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 31, 2012

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 PA10004066 WA Primary

Addresses

Primary practice location

33501 1St Way S
Federal Way, WA 98003-6208

Mailing address

1100 9TH Ave
Ms M4-PA
Seattle, WA 98101-2756
Phone (206) 515-5811

Other identifiers 5

IdentifierTypeStateIssuer
970030800OtherWARAILROAD MC#
0335JOOtherWABLUE SHIELD #
8362543MedicaidWA
0039594OtherWALABOR AND INDUSTRIES #
US7233432OtherWAAETNA SPECIALIST PIN

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
I20100219000731 WA Practitioner - Physician Assistant 4587708169 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Virginia Mason Medical CenterGroup PAC ID 9830002617, 867 clinicians

Practice addresses (Care Compare)

1100 9TH Ave
Seattle, WA 98101-2756
Phone (206) 223-6600

33501 1St Way S
Federal Way, WA 98003-6208
Phone (253) 838-2400

4575 Sand Point Way NE
Suite 108
Seattle, WA 98105-3999
Phone (206) 525-8000

925 Seneca St
Seattle, WA 98101-2742
Phone (206) 223-6600

Hospital & facility affiliations

  • Virginia Mason Medical Center Hospital, Seattle, WA, CCN 500005

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA10004066WAMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Virginia Mason Medical Center CurrentSince Feb 10, 2003 Accepting new patients
Virginia Mason Medical Center CurrentSince Feb 10, 2003 Accepting new patients

Locations

380 Winslow Way E
Bainbridge Island, WA 98110
Phone (206) 842-5632

33501 1st Way S
Federal Way, WA 98003
Phone (253) 838-2400

925 Seneca St
Seattle, WA 98101
Phone (206) 341-0860

1100 9th Ave
#M4
Seattle, WA 98101
Phone (206) 515-5811

4575 Sand Point Way NE
Ste 108
Seattle, WA 98105
Phone (206) 525-8000

1100 9th Ave
#6
Seattle, WA 98101
Phone (206) 223-6861

1100 9th Ave
Seattle, WA 98101
Phone (206) 223-6980

Interoperability endpoints

  • Direct secure messaging: theresa.jovanovich@direct.vmmc.org

Organizations & group practices 17

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.

View all 17

Hospital & facility affiliations 1

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": "1168300800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1356912000000",
    "number": "1356490486",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 9TH AVE",
            "address_2": "MS M4-PA",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981012756",
            "telephone_number": "206-515-5811",
            "fax_number": "206-515-5886"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "33501 1ST WAY S",
            "city": "FEDERAL WAY",
            "state": "WA",
            "postal_code": "980036208",
            "telephone_number": "253-838-2400",
            "fax_number": "253-874-1634"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOVANOVICH",
        "first_name": "THERESA",
        "middle_name": "A",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-09",
        "last_updated": "2012-12-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "WA",
            "license": "PA10004066",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MC#",
            "identifier": "970030800",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD #",
            "identifier": "0335JO",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8362543",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LABOR AND INDUSTRIES #",
            "identifier": "0039594",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA SPECIALIST PIN",
            "identifier": "US7233432",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Federal Way, WA

Sources for this page

Verify at the official NPI Registry.