Individual provider Active NPI

Mie Hagiwara, PA-C

  • Surgical Physician Assistant
  • Renton, WA
National Provider Identifier
1508263716
Registry record updated Jan 31, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
PA60509719 Issued in WA
Practice address
4011 Talbot Rd S
Suite 300
Renton, WA 98055-5773
Phone
(425) 656-5060
Fax
(425) 656-5047
NPI assigned
Dec 3, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 31, 2017

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA60509719 WA
Medical Physician Assistant 363AM0700X PA60509719 WA
Surgical Physician Assistant 363AS0400X PA60509719 WA Primary

Addresses

Primary practice location

4011 Talbot Rd S
Suite 300
Renton, WA 98055-5773

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
2041661MedicaidWA

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
I20150128000003 WA Practitioner - Physician Assistant 0244554053 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Proliance Surgeons Inc P SGroup PAC ID 8527972900, 395 clinicians

Practice addresses (Care Compare)

4011 Talbot Rd S
Suite 300
Renton, WA 98055-5791
Phone (206) 656-5060

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA60509719WAMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Proliance Surgeons Inc P S Physician Assistant CurrentSince Feb 25, 2017 Accepting new patients
Proliance Surgeons Inc., P.S. Surgical Current Accepting new patients
Proliance Surgeons Inc P S Surgical CurrentSince Feb 25, 2017 Accepting new patients

Locations

17700 SE 272nd St
Kent, WA 98042
Phone (253) 372-6500

4011 Talbot Rd S
Ste 300
Renton, WA 98055
Phone (206) 656-5060

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 and National Provider Directory roles.

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": "1417564800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1485820800000",
    "number": "1508263716",
    "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": "4011 TALBOT RD S",
            "address_2": "SUITE 300",
            "city": "RENTON",
            "state": "WA",
            "postal_code": "980555773",
            "telephone_number": "425-656-5060",
            "fax_number": "425-656-5047"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAGIWARA",
        "first_name": "MIE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-12-03",
        "last_updated": "2017-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "PA60509719",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "WA",
            "license": "PA60509719",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "WA",
            "license": "PA60509719",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2041661",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Renton, WA

Sources for this page

Verify at the official NPI Registry.