Individual provider Active NPI

Sarah Severance Goble, MPAS, PA-C

  • Medical Physician Assistant
  • Kirkland, WA
National Provider Identifier
1427300565
Registry record updated Jun 29, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
60316579 Issued in WA
Practice address
12911 120TH Ave NE
Suite H-210
Kirkland, WA 98034-3027
Phone
(425) 823-4000
Fax
(425) 821-3550
NPI assigned
Oct 14, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 29, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 60316579 WA Primary
Surgical Physician Assistant 363AS0400X PA60316579 WA

Addresses

Primary practice location

12911 120TH Ave NE
Suite H-210
Kirkland, WA 98034-3027

Mailing address

805 Madison St
Suite 901
Seattle, WA 98104-1172
Phone (206) 264-8100

Other names 1

  • Sarah Renee Severance Former name

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
I20121228000490 WA Practitioner - Physician Assistant 5395998207 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Proliance Surgeons Inc P SGroup PAC ID 8527972900, 395 clinicians

Practice addresses (Care Compare)

12911 120TH Ave NE
Suite H210
Kirkland, WA 98034-3065
Phone (425) 823-4000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
60316579WAMDMedical Physician Assistant
PA60316579WAMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Proliance Surgeons, Inc., P.S. CurrentSince Jul 5, 2016 Accepting new patients
Proliance Surgeons Inc P S Surgical CurrentSince Jul 5, 2016 Accepting new patients
Sports and Spine Past Accepting new patients

Locations

12911 120th Ave NE
Ste G10
Kirkland, WA 98034
Phone (425) 481-6301

12911 120th Ave NE
Ste H120
Kirkland, WA 98034
Phone (425) 823-4226

12911 120th Ave NE
Ste H210
Kirkland, WA 98034
Phone (425) 823-4000

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

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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": "1350172800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1467158400000",
    "number": "1427300565",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "805 MADISON ST",
            "address_2": "SUITE 901",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981041172",
            "telephone_number": "206-264-8100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12911 120TH AVE NE",
            "address_2": "SUITE H-210",
            "city": "KIRKLAND",
            "state": "WA",
            "postal_code": "980343027",
            "telephone_number": "425-823-4000",
            "fax_number": "425-821-3550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOBLE",
        "first_name": "SARAH",
        "middle_name": "SEVERANCE",
        "name_prefix": "Mrs.",
        "credential": "MPAS, PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-10-14",
        "last_updated": "2016-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "WA",
            "license": "60316579",
            "primary": true
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "WA",
            "license": "PA60316579",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SARAH",
            "last_name": "SEVERANCE",
            "middle_name": "RENEE",
            "credential": "MPAS, PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Kirkland, WA

Sources for this page

Verify at the official NPI Registry.