Individual provider Active NPI

Titus Koipaton Sairo, FNP-C

  • Family Nurse Practitioner
  • Tacoma, WA
National Provider Identifier
1528510898
Registry record updated Jan 19, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
61004280 Issued in WA
Practice address
1201 Pacific Ave Ste 400
Tacoma, WA 98402-4381
Phone
(253) 300-8453
NPI assigned
Nov 2, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 19, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X AP131522 TX
Family Nurse Practitioner 363LF0000X RN188920 GA
Family Nurse Practitioner 363LF0000X 61004280 WA Primary

Addresses

Primary practice location

1201 Pacific Ave Ste 400
Tacoma, WA 98402-4381

Mailing address

315 Boulevard NE Ste 310
Atlanta, GA 30312-1264
Phone (678) 371-8222

Other practice location 1

315 Boulevard NE Ste 310
Atlanta, GA 30312-1264
Phone (678) 371-8222

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
I20191203001471 WA Practitioner - Nurse Practitioner 9739512898 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
RN188920GAMDFamily Nurse Practitioner
AP131522TXMDFamily Nurse Practitioner
61004280WAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Molina Healthcare of Washington, Inc CurrentSince Apr 5, 2021 Accepting new patients
Molina Healthcare of Washington, Inc Current Accepting new patients
SHC Medical Center Toppenish Current Accepting new patients
Sunnyside Community Hospital Association Family CurrentSince Oct 4, 2019 Accepting new patients
Sunnyside Community Hospital Association Current Accepting new patients
Sunnyside Community Hospital Association CurrentSince Oct 4, 2019 Accepting new patients
SHC Medical Center Toppenish CurrentSince Jan 1, 2020 Accepting new patients

Locations

200 Oceangate
Ste 100
Long Beach, CA 90802
Phone (562) 435-3666

15 SW Everett Mall Way
Ste A
Everett, WA 98204
Phone (425) 348-6727

222 E 2nd St
Grandview, WA 98930
Phone (509) 203-6501

355 Chardonnay Ave
Prosser, WA 99350
Phone (509) 781-6366

2705 E Lincoln Ave
Sunnyside, WA 98944
Phone (509) 836-4848

2925 Allen Rd
Sunnyside, WA 98944
Phone (509) 837-4949

502 W 4th Ave
Toppenish, WA 98948
Phone (509) 575-5000

1420 Ahtanum Ridge Dr
Union Gap, WA 98903
Phone (509) 454-7700

110 S 9th Ave
Yakima, WA 98902
Phone (509) 575-5000

1005 W Walnut St
Ste 120
Yakima, WA 98902
Phone (509) 248-6080

Interoperability endpoints

  • Direct secure messaging: tsairo12407@direct-prd.molinahealthcare.com

Organizations & group practices 8

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": "1478044800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611014400000",
    "number": "1528510898",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "315 BOULEVARD NE STE 310",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303121264",
            "telephone_number": "678-371-8222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 PACIFIC AVE STE 400",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984024381",
            "telephone_number": "253-300-8453"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "315 Boulevard NE Ste 310",
            "address_purpose": "LOCATION",
            "city": "Atlanta",
            "state": "GA",
            "postal_code": "303121264",
            "country_code": "US",
            "telephone_number": "678-371-8222",
            "fax_number": "678-705-2378",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SAIRO",
        "first_name": "TITUS",
        "middle_name": "KOIPATON",
        "name_prefix": "Mr.",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-11-02",
        "last_updated": "2021-01-19",
        "certification_date": "2021-01-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "AP131522",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN188920",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WA",
            "license": "61004280",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tacoma, WA

Sources for this page

Verify at the official NPI Registry.