Active NPI
John Herrera, PA
- Physician Assistant
- Olympia, WA
National Provider Identifier
1467493767
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 1016774
- Practice address
- 413 Lilly Rd NE
Olympia, WA 98506-5133 - Phone
- (360) 491-9480
- NPI assigned
- Jun 9, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 1016774 | WA | Primary |
Addresses
Primary practice location
413 Lilly Rd NE
Olympia, WA 98506-5133
Mailing address
PO Box 5007
Lacey, WA 98509-5007
Phone (800) 599-0166
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8935586 | Other | WA CRIME VICTIMS | |
| 0153539 | Other | WA L & I | |
| A012 | Other | CHAMPUS | |
| 1659HE | Other | REGENCE BS | |
| 8358236 | Medicaid | WA |
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)
- Not enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1016774 | WA | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Olympia Emergency Services, PLLC | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Emergency Medicine Physician
- Olympia, WA
- NPI 1346267796
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149811200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1196121600000",
"number": "1467493767",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 5007",
"city": "LACEY",
"state": "WA",
"postal_code": "985095007",
"telephone_number": "800-599-0166"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "413 LILLY RD NE",
"city": "OLYMPIA",
"state": "WA",
"postal_code": "985065133",
"telephone_number": "360-491-9480"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HERRERA",
"first_name": "JOHN",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-09",
"last_updated": "2007-11-27",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "WA",
"license": "1016774",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WA CRIME VICTIMS",
"identifier": "8935586",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WA L & I",
"identifier": "0153539",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CHAMPUS",
"identifier": "A012",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "REGENCE BS",
"identifier": "1659HE",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8358236",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Olympia, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.