Individual provider Active NPI

Shane Robert Egresi, PHYSICIAN ASSISTANT

  • Medical Physician Assistant
  • Kirkland, WA
National Provider Identifier
1508384371
Registry record updated Aug 31, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
Practice address
12040 NE 128TH St
Kirkland, WA 98034-3013
Phone
(330) 429-2289
NPI assigned
Aug 31, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 31, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X Primary

Addresses

Primary practice location

12040 NE 128TH St
Kirkland, WA 98034-3013

Mailing address

2304 Meadow Village Dr
Columbus, OH 43235-4923
Phone (330) 429-2289

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
I20171205000484 WA Practitioner - Physician Assistant 5698032324 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
King County Public Hospital District No 2Group PAC ID 7618880097, 586 clinicians

Practice addresses (Care Compare)

12033 NE 130TH LN
Suite 120
Kirkland, WA 98034-3052
Phone (425) 899-2160

12039 NE 128TH St
Kirkland, WA 98034-3029

12040 NE 128TH St
Kirkland, WA 98034-3013

12040 NE 128TH St Ms
Suite 55
Kirkland, WA 98034-3013

12333 NE 130TH LN
Kirkland, WA 98034-7467

Hospital & facility affiliations

  • Evergreenhealth Medical Center Hospital, Kirkland, WA, CCN 500124
  • Evergreenhealth Monroe Hospital, Monroe, WA, CCN 500084
  • Fred Hutchinson Cancer Center Hospital, Seattle, WA, CCN 500138

Merit-based Incentive Payment System (MIPS)

Final score
86.73 of 100Reported as apm
Quality
73.46
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
King County Public Hospital District No 2 Current Accepting new patients
King County Public Hospital District No 2 CurrentSince Nov 21, 2017 Accepting new patients
King County Public Hospital District No. 2 CurrentSince Nov 21, 2017 Accepting new patients

Locations

1909 214th St SE
Ste 110
Bothell, WA 98021
Phone (425) 488-4988

1321 Colby Ave
Ofc
Everett, WA 98201
Phone (425) 261-4076

12039 NE 128th St
Ste 300
Kirkland, WA 98034
Phone (425) 899-3123

12333 NE 130th Ln
Ste 320
Kirkland, WA 98034
Phone (206) 899-0555

12040 NE 128th St
Kirkland, WA 98034
Phone (425) 899-1000

14701 179th Ave SE
Monroe, WA 98272
Phone (360) 794-1409

8980 161st Ave NE
Ste 400
Redmond, WA 98052
Phone (425) 883-3404

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 5

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": "1504137600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1504137600000",
    "number": "1508384371",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2304 MEADOW VILLAGE DR",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432354923",
            "telephone_number": "330-429-2289"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12040 NE 128TH ST",
            "city": "KIRKLAND",
            "state": "WA",
            "postal_code": "980343013",
            "telephone_number": "330-429-2289"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EGRESI",
        "first_name": "SHANE",
        "middle_name": "ROBERT",
        "credential": "PHYSICIAN ASSISTANT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-08-31",
        "last_updated": "2017-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kirkland, WA

Sources for this page

Verify at the official NPI Registry.