NPIMap

Individual provider Active NPI

Martin Muy-Rivera, PA-C

  • Physician Assistant
  • Renton, WA
National Provider Identifier
1457540825
Registry record updated Jul 19, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA10005323 Issued in WA
Practice address
500 SW 39TH St
Suite 150
Renton, WA 98057-4915
Phone
(425) 264-2568
Fax
(425) 264-2569
NPI assigned
Oct 22, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 19, 2019

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 PA10005323 WA
Physician Assistant 363A00000X PA10005323 WA Primary

Addresses

Primary practice location

500 SW 39TH St
Suite 150
Renton, WA 98057-4915

Mailing address

500 SW 39TH St
Suite 150
Renton, WA 98057-4915
Phone (425) 264-2568

Other practice location 1

6240 Tacoma Mall Blvd Ste 101
Tacoma, WA 98409-6819
Phone (253) 271-9720

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Multicare Health System CurrentSince Jan 7, 2019 Accepting new patients
Multicare Health System CurrentSince Jan 7, 2019 Accepting new patients
Dispatchhealth Advanced Care - Washington PC PastSince Oct 21, 2020 Accepting new patients
Multicare Health System Physician Assistant 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

316 S K St
Tacoma, WA 98405
Phone (253) 403-1375

3124 S 19th St
Ste 340
Tacoma, WA 98405
Phone (253) 459-7000

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1193011200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1563494400000",
    "number": "1457540825",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 SW 39TH ST",
            "address_2": "SUITE 150",
            "city": "RENTON",
            "state": "WA",
            "postal_code": "980574915",
            "telephone_number": "425-264-2568",
            "fax_number": "425-264-2569"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 SW 39TH ST",
            "address_2": "SUITE 150",
            "city": "RENTON",
            "state": "WA",
            "postal_code": "980574915",
            "telephone_number": "425-264-2568",
            "fax_number": "425-264-2569"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6240 Tacoma Mall Blvd Ste 101",
            "address_purpose": "LOCATION",
            "city": "Tacoma",
            "state": "WA",
            "postal_code": "984096819",
            "country_code": "US",
            "telephone_number": "253-271-9720",
            "fax_number": "253-212-3372",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MUY-RIVERA",
        "first_name": "MARTIN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-10-22",
        "last_updated": "2019-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "WA",
            "license": "PA10005323",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "PA10005323",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Renton, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.