NPIMap

Individual provider Active NPI

Elisabeth Rose Dean, PA-C

  • Physician Assistant
  • Port Orchard, WA
National Provider Identifier
1558665455
Registry record updated Apr 26, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA60736525 Issued in WA
Practice address
450 S Kitsap Blvd Ste 100
Port Orchard, WA 98366-3709
Phone
(360) 744-6275
Fax
(360) 744-6270
NPI assigned
Jan 6, 2011
Last updated
Apr 26, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 26, 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 PA60736525 WA Primary

Addresses

Primary practice location

450 S Kitsap Blvd Ste 100
Port Orchard, WA 98366-3709

Mailing address

450 S Kitsap Blvd Ste 100
Port Orchard, WA 98366-3709
Phone (360) 744-4390

Other identifiers 1

IdentifierTypeStateIssuer
2077317MedicaidWA

Other names 1

  • Elisabeth Rose Tiefenback Former name

Electronic endpoints 3

TypeEndpointUseAffiliation
Direct Messaging Address edean245456@fhsce.catholichealth.net Direct Franciscan Medical Group
Other URL Www.vmfh.org
CONNECT URL VMFH.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA, WA2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20110408000225 VA Practitioner - Physician Assistant 9739363193 Reassigns benefits to 2 organizations
I20170802001899 WA Practitioner - Physician Assistant 9739363193 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1148 Broadway
Suite 100
Tacoma, WA 98402-3513

5000 Hopyard Rd
Pleasanton, CA 94588-3146

505 S 336TH St
Suite 600
Federal Way, WA 98003-5947

555 Cajon St
Suite a
Redlands, CA 92373-5980

PO Box
Suite 2029
Concrete, WA 98237

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Riverside Physician Services Inc CurrentSince Jan 6, 2011 Accepting new patients
Franciscan Medical Group CurrentSince Sep 27, 2019 Accepting new patients
Riverside Physician Services Inc CurrentSince Jan 6, 2011 Accepting new patients
VA-I Medical Services PC Physician Assistant Past Accepting new patients
Franciscan Medical Group Physician Assistant Past Accepting new patients
Ehra Medical Services of Virginia, PC Past Accepting new patients
Riverside Physician Services, Inc. Past Accepting new patients
Virginia Emergency Group LLC Past Accepting new patients
Riverside Physician Services Inc Past Accepting new patients

Locations

7519 Hospital Dr
Gloucester, VA 23061
Phone (804) 693-8800

856 J Clyde Morris Blvd
Ste A
Newport News, VA 23601
Phone (757) 316-5900

858 J Clyde Morris Blvd
Newport News, VA 23601
Phone (757) 594-4343

1500 Commonwealth Ave
Williamsburg, VA 23185
Phone (757) 585-2200

34515 9th Ave S
Federal Way, WA 98003
Phone (253) 835-8100

450 S Kitsap Blvd
Ste 100
Port Orchard, WA 98366
Phone (360) 744-6275

1717 S J St
Tacoma, WA 98405
Phone (253) 426-4101

1812 S J St
Ste 120
Tacoma, WA 98405
Phone (253) 428-2200

Interoperability endpoints

  • Direct secure messaging: edean245456@fhsce.catholichealth.net

Organizations & group practices 14

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

View all 14

Hospital & facility affiliations 4

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": "1294272000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1650931200000",
    "number": "1558665455",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "450 S KITSAP BLVD STE 100",
            "city": "PORT ORCHARD",
            "state": "WA",
            "postal_code": "983663709",
            "telephone_number": "360-744-4390"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "450 S KITSAP BLVD STE 100",
            "city": "PORT ORCHARD",
            "state": "WA",
            "postal_code": "983663709",
            "telephone_number": "360-744-6275",
            "fax_number": "360-744-6270"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEAN",
        "first_name": "ELISABETH",
        "middle_name": "ROSE",
        "name_prefix": "Miss",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-01-06",
        "last_updated": "2022-04-26",
        "certification_date": "2022-04-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "PA60736525",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2077317",
            "state": "WA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "edean245456@fhsce.catholichealth.net",
            "affiliation": "Y",
            "affiliationName": "Franciscan Medical Group",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "450 S Kitsap Blvd Ste 100",
            "city": "Port Orchard",
            "state": "WA",
            "country_code": "US",
            "postal_code": "983663709",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Www.vmfh.org",
            "affiliation": "N",
            "address_1": "450 S Kitsap Blvd Ste 100",
            "city": "Port Orchard",
            "state": "WA",
            "country_code": "US",
            "postal_code": "983663709",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "VMFH.org",
            "affiliation": "N",
            "address_1": "450 S Kitsap Blvd Ste 100",
            "city": "Port Orchard",
            "state": "WA",
            "country_code": "US",
            "postal_code": "983663709",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "ELISABETH",
            "last_name": "TIEFENBACK",
            "middle_name": "ROSE",
            "credential": "PA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Port Orchard, WA

Sources for this page

Verify at the official NPI Registry.