Individual provider Active NPI

Sierra Butler, PA-C

  • Physician Assistant
  • Moses Lake, WA
National Provider Identifier
1487216420
Registry record updated Jun 3, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA60971025 Issued in WA
Practice address
605 S Coolidge St
Moses Lake, WA 98837-1893
Phone
(509) 765-0674
Fax
(509) 764-0344
NPI assigned
Jun 29, 2019
Last updated
Jun 3, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 3, 2021

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 PA60971025 WA Primary

Addresses

Primary practice location

605 S Coolidge St
Moses Lake, WA 98837-1893

Mailing address

605 S Coolidge St
Moses Lake, WA 98837-1893
Phone (509) 765-0674

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
I20200129001960 WA Practitioner - Physician Assistant 6002242781 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1450 1St Ave SW
Quincy, WA 98848-1695
Phone (509) 787-6423

605 S Coolidge St
Suite 101
Moses Lake, WA 98837-1893
Phone (509) 765-0674

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA60971025WAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Moses Lake Community Health Center CurrentSince Nov 11, 2019 Accepting new patients
Moses Lake Community Health Center Past Accepting new patients

Locations

605 S Coolidge St
Moses Lake, WA 98837
Phone (509) 765-0674

605 S Coolidge St
#101
Moses Lake, WA 98837
Phone (509) 765-0674

1450 1st Ave SW
Quincy, WA 98848
Phone (509) 787-6423

Organizations & group practices 2

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 2

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": "1561766400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1622678400000",
    "number": "1487216420",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "605 S COOLIDGE ST",
            "city": "MOSES LAKE",
            "state": "WA",
            "postal_code": "988371893",
            "telephone_number": "509-765-0674",
            "fax_number": "509-764-0344"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "605 S COOLIDGE ST",
            "city": "MOSES LAKE",
            "state": "WA",
            "postal_code": "988371893",
            "telephone_number": "509-765-0674",
            "fax_number": "509-764-0344"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUTLER",
        "first_name": "SIERRA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-06-29",
        "last_updated": "2021-06-03",
        "certification_date": "2021-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "PA60971025",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Moses Lake, WA

Sources for this page

Verify at the official NPI Registry.