NPIMap

Individual provider Active NPI

Christopher Joel Shaw, PA-C

  • Physician Assistant
  • Kirkland, WA
National Provider Identifier
1407179690
Registry record updated Feb 9, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA60124508 Issued in WA
Practice address
11800 NE 128TH St
Suite 300
Kirkland, WA 98034-7208
Phone
(425) 814-5100
Fax
(425) 814-5103
NPI assigned
Mar 2, 2010
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 9, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA60124508 WA Primary

Addresses

Primary practice location

11800 NE 128TH St
Suite 300
Kirkland, WA 98034-7208

Mailing address

13236 NE 129TH PL
Kirkland, WA 98034-3361
Phone (425) 814-5100

Other identifiers 3

IdentifierTypeStateIssuer
P00946049OtherWARAILROAD MEDICARE
0260915OtherWAL AND I
1407179690MedicaidWA

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
I20100506000638 WA Practitioner - Physician Assistant 0547398836 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

14720 Main St NE
Suite 109
Duvall, WA 98019-8460
Phone (425) 788-4889

16916 140TH Ave NE
Woodinville, WA 98072-6957

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA60124508WAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
King County Public Hospital District No. 2 CurrentSince Sep 5, 2018 Accepting new patients
King County Public Hospital District No. 2 CurrentSince Sep 5, 2018 Accepting new patients
Virginia Mason Medical Center CurrentSince Mar 15, 2010 Accepting new patients
Virginia Mason Medical Center CurrentSince Mar 15, 2010 Accepting new patients
King County Public Hospital District No 2 Past Accepting new patients

Locations

14720 Main St NE
Ste 109
Duvall, WA 98019
Phone (425) 788-4889

12039 NE 128th St
Ste 300
Kirkland, WA 98034
Phone (425) 899-3123

11800 NE 128th St
Ste 300
Kirkland, WA 98034
Phone (425) 814-5100

12040 NE 128th St
#10
Kirkland, WA 98034
Phone (206) 466-0369

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

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

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

16916 140th Ave NE
Ste 300
Woodinville, WA 98072
Phone (425) 481-6363

Organizations & group practices 7

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 4

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": "1267488000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1423440000000",
    "number": "1407179690",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13236 NE 129TH PL",
            "city": "KIRKLAND",
            "state": "WA",
            "postal_code": "980343361",
            "telephone_number": "425-814-5100",
            "fax_number": "425-814-5103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11800 NE 128TH ST",
            "address_2": "SUITE 300",
            "city": "KIRKLAND",
            "state": "WA",
            "postal_code": "980347208",
            "telephone_number": "425-814-5100",
            "fax_number": "425-814-5103"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAW",
        "first_name": "CHRISTOPHER",
        "middle_name": "JOEL",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-03-02",
        "last_updated": "2015-02-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "PA60124508",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00946049",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "L AND I",
            "identifier": "0260915",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1407179690",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kirkland, WA

Sources for this page

Verify at the official NPI Registry.