NPIMap

Individual provider Active NPI

Joseph Province, PA

  • Surgical Physician Assistant
  • Vancouver, WA
National Provider Identifier
1558797365
Registry record updated Oct 28, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
PA61208141 Issued in WA
Practice address
200 NE Mother Joseph PL Ste 210
Vancouver, WA 98664-3295
Phone
(360) 254-6161
Fax
(360) 449-1146
NPI assigned
Sep 25, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X PA9107470 FL
Surgical Physician Assistant 363AS0400X PA182241 OR
Surgical Physician Assistant 363AS0400X PA61208141 WA Primary

Addresses

Primary practice location

200 NE Mother Joseph PL Ste 210
Vancouver, WA 98664-3295

Mailing address

200 NE Mother Joseph PL Ste 210
Vancouver, WA 98664-3295
Phone (360) 254-6161

Other identifiers 1

IdentifierTypeStateIssuer
010158600MedicaidFL

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211103002496 WA Practitioner - Physician Assistant 6305073412 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA182241ORMDSurgical Physician Assistant
PA61208141WAMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Northwest Surgical Specialists PC CurrentSince Dec 1, 2021 Accepting new patients
Northwest Surgical Specialists, P.C. CurrentSince Dec 1, 2021 Accepting new patients
Gateway Radiology Consultants, P.a. Past Accepting new patients
Orthopedic Specialists of SW Florida, P.a. Past Accepting new patients

Locations

200 NE Mother Joseph Pl
Ste 110
Vancouver, WA 98664
Phone (360) 256-8584

200 NE Mother Joseph Pl
Ste 210
Vancouver, WA 98664
Phone (360) 449-1145

3205 SE 192nd Ave
Ste 105
Vancouver, WA 98683

200 NE Mother Joseph Pl
Vancouver, WA 98664
Phone (360) 514-2990

Interoperability endpoints

  • Direct secure messaging: joseph.provincepac.p1@direct.reboundmd.nextgenshare.com
  • Direct secure messaging: jprovince21865@reboundmd.gardenplot.direct-ci.com

Organizations & group practices 11

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.

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Northwest Surgical Specialists PC 118 clinicians

Practice addresses (Care Compare)

200 NE Mother Joseph PL
110 Rebound Orthopedics
Vancouver, WA 98664-3293
Phone (360) 254-6161

200 NE Mother Joseph PL
Suite 210
Vancouver, WA 98664-3295

2211 NE 139TH St
Legacy Salmon Creek Medical Center
Vancouver, WA 98686-2742
Phone (360) 487-1000

400 NE Mother Joseph PL
Peacehealth Southwest Medical Center
Vancouver, WA 98664-3200
Phone (360) 514-2000

Hospital & facility affiliations

  • Peacehealth Southwest Medical Cente Hospital, Vancouver, WA, CCN 500050

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Promoting interoperability
100
Improvement activities
40

NPI Registry JSON

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

{
    "created_epoch": "1380067200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635379200000",
    "number": "1558797365",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 NE MOTHER JOSEPH PL STE 210",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986643295",
            "telephone_number": "360-254-6161",
            "fax_number": "360-449-1146"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 NE MOTHER JOSEPH PL STE 210",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986643295",
            "telephone_number": "360-254-6161",
            "fax_number": "360-449-1146"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROVINCE",
        "first_name": "JOSEPH",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-09-25",
        "last_updated": "2021-10-28",
        "certification_date": "2021-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "FL",
            "license": "PA9107470",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "OR",
            "license": "PA182241",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "WA",
            "license": "PA61208141",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010158600",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Vancouver, WA

Sources for this page

Verify at the official NPI Registry.