Krista Decoursey Washburn, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

085.005580 Issued in IL

Practice address

5140 N California Ave
Suite 780
Chicago, IL 60625-3645

Phone

(773) 907-1035

Fax

(773) 907-3245

NPI assigned

Sep 24, 2015

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Krista Decoursey Former name

Medicare fee-for-service enrollment

Enrolled in OR

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

Specialty

Physician Assistant

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Valley Immediate Care, LLCGroup PAC ID 7618876723, 36 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

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.

• Valley Immediate Care, LLC

  • Urgent Care Clinic/Center
  • Medford, OR
  • NPI 1982709226
  Medicare reassignment Care Compare group
• Valley Immediate Care, LLC

  • Non-Pharmacy Dispensing Site
  • Grants Pass, OR
  • NPI 1821504192
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1443052800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1462752000000",
    "number": "1538538129",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5140 N CALIFORNIA AVE",
            "address_2": "SUITE 780",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606253645",
            "telephone_number": "773-907-1035",
            "fax_number": "773-907-3245"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5140 N CALIFORNIA AVE",
            "address_2": "SUITE 780",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606253645",
            "telephone_number": "773-907-1035",
            "fax_number": "773-907-3245"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WASHBURN",
        "first_name": "KRISTA",
        "middle_name": "DECOURSEY",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-09-24",
        "last_updated": "2016-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "IL",
            "license": "085.005580",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KRISTA",
            "last_name": "DECOURSEY",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Hattie Mae Wash, PSYD
• Katherine Washagan, PA-C
• Rachel Marie Washart
• Jason J. Washburn, PH.D., ABPP
• Kathryn Jane Washburn, M.S. SLP
• Washington and Jane Smith Community Beverly
• Katie Odette Washington Cole, MD-PHD
• Washington Heights Care Center, LLC
• Washington International Solutions LLC
• Ann Wood Washington, PH.D.

• Medical Physician Assistant in Chicago, IL
• Providers in Chicago, IL by specialty
• Medical Physician Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.