Individual provider Active NPI

Michael John Perez II

  • Physician Assistant
  • Spokane Valley, WA
National Provider Identifier
1497209571
Registry record updated Feb 4, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA60794753 Issued in WA
Practice address
1502 N Vercler Rd
Spokane Valley, WA 99216-1078
Phone
(509) 444-8204
Fax
(509) 434-0321
NPI assigned
Aug 7, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 4, 2022

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 PA60794753 WA Primary

Addresses

Primary practice location

1502 N Vercler Rd
Spokane Valley, WA 99216-1078

Mailing address

611 N Iron Bridge Way
Spokane, WA 99202-4932
Phone (509) 444-8888

Other practice location 1

16528 E Desmet Ct
Spokane Valley, WA 99216-3522
Phone (509) 944-8910

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mperez219100@wm.providencedirect.org Direct

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
I20180116000930 WA Practitioner - Physician Assistant 1658630843 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA60794753WAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Community Health Association of Spokane CurrentSince Dec 12, 2017 Accepting new patients
Community Health Association of Spokane CurrentSince Dec 12, 2017 Accepting new patients

Locations

611 N Iron Bridge Way
Spokane, WA 99202

5901 N Lidgerwood St
Ste 126
Spokane, WA 99208
Phone (509) 434-1990

1001 W 2nd Ave
Spokane, WA 99201
Phone (509) 835-1205

203 N Washington St
Ste 300
Spokane, WA 99201

1502 N Vercler Rd
Spokane Valley, WA 99216
Phone (509) 444-8204

15812 E Indiana Ave
Ste 101
Spokane Valley, WA 99216

Interoperability endpoints

  • Direct secure messaging: mperez219100@wm.providencedirect.org

Organizations & group practices 3

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": "1470528000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643932800000",
    "number": "1497209571",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "611 N IRON BRIDGE WAY",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992024932",
            "telephone_number": "509-444-8888",
            "fax_number": "509-444-7806"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1502 N VERCLER RD",
            "city": "SPOKANE VALLEY",
            "state": "WA",
            "postal_code": "992161078",
            "telephone_number": "509-444-8204",
            "fax_number": "509-434-0321"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "16528 E Desmet Ct",
            "address_purpose": "LOCATION",
            "city": "Spokane Valley",
            "state": "WA",
            "postal_code": "992163522",
            "country_code": "US",
            "telephone_number": "509-944-8910",
            "fax_number": "509-474-6606",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PEREZ",
        "first_name": "MICHAEL",
        "middle_name": "JOHN",
        "name_suffix": "II",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-08-07",
        "last_updated": "2022-02-04",
        "certification_date": "2022-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "PA60794753",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mperez219100@wm.providencedirect.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "16528 E Desmet Ct",
            "city": "Spokane Valley",
            "state": "WA",
            "country_code": "US",
            "postal_code": "992163522",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Spokane Valley, WA

Sources for this page

Verify at the official NPI Registry.