Individual provider Active NPI

Jenna Mylin, PA-C

  • Surgical Physician Assistant
  • Tacoma, WA
National Provider Identifier
1376274530
Registry record updated Apr 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
PA61482415 Issued in WA
Practice address
419 S L St
Tacoma, WA 98405-3799
Phone
(253) 403-7257
Fax
(253) 403-1340
NPI assigned
Jun 20, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X PA61482415 WA Primary
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

419 S L St
Tacoma, WA 98405-3799

Mailing address

PO Box 5299
Ms: 820-5-Pco
Tacoma, WA 98415-0299

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
I20240111002161 WA Practitioner - Physician Assistant 5698126803 Reassigns benefits to 1 organization

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
Multicare Health SystemGroup PAC ID 7719899897, 2,312 clinicians

Practice addresses (Care Compare)

4700 Point Fosdick Dr
Gig Harbor, WA 98335-1706

Hospital & facility affiliations

  • Tacoma General Allenmore Hospital Hospital, Tacoma, WA, CCN 500129

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA61482415WAMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Multicare Health System CurrentSince Dec 6, 2023 Accepting new patients
Multicare Health System CurrentSince Dec 6, 2023 Accepting new patients
Multicare Health System Past Accepting new patients

Locations

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

222 State Ave N
Kent, WA 98030
Phone (253) 372-7680

315 S K St
Tacoma, WA 98405
Phone (253) 403-1291

Interoperability endpoints

  • Direct secure messaging: jmylin1027691@direct.hopkinsmedicine.org

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 and National Provider Directory roles.

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": "1655683200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714348800000",
    "number": "1376274530",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5299",
            "address_2": "MS: 820-5-PCO",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984150299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "419 S L ST",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984053799",
            "telephone_number": "253-403-7257",
            "fax_number": "253-403-1340"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MYLIN",
        "first_name": "JENNA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-06-20",
        "last_updated": "2024-04-29",
        "certification_date": "2024-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "WA",
            "license": "PA61482415",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tacoma, WA

Sources for this page

Verify at the official NPI Registry.