NPIMap

Individual provider Active NPI

Lindsay Lidia Nourse, PA-C

  • Physician Assistant
  • Olympia, WA
National Provider Identifier
1568790384
Registry record updated Jun 18, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA60208834 Issued in WA
Practice address
1620 Cooper Point Rd SW
Olympia, WA 98502-5736
Phone
(360) 486-6710
Fax
(360) 705-0269
NPI assigned
Dec 7, 2009
Last updated
Jun 18, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 18, 2021

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 PA60208834 WA Primary

Addresses

Primary practice location

1620 Cooper Point Rd SW
Olympia, WA 98502-5736

Mailing address

PO Box 3360
Portland, OR 97208-3360

Other practice location 1

1217 Cooper Point Rd SW
Olympia, WA 98502-7204
Phone (360) 486-2900

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address lnourse969129@wm.providencedirect.org Direct

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
I20100104000418 WA Practitioner - Physician Assistant 5991846644 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
David Penner MD PLLCGroup PAC ID 6507246956, 2 clinicians

Practice addresses (Care Compare)

1801 W Bay Dr NW
Suite 104
Olympia, WA 98502-4310
Phone (360) 539-1736

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA60208834WAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Grays Harbor County Public Hospital District No 1 CurrentSince Feb 15, 2014 Accepting new patients
Providence Health & Services Washington CurrentSince Oct 15, 2018 Accepting new patients
Grays Harbor County Public Hospital District No 1 Current Accepting new patients
Grays Harbor County Public Hospital District No. 1 CurrentSince Feb 15, 2014 Accepting new patients
Lewis County Community Health Services Past Accepting new patients
Providence Health & Services Washington Past Accepting new patients

Locations

600 E Main St
Elma, WA 98541
Phone (360) 346-2222

1620 Cooper Point Rd SW
Olympia, WA 98502
Phone (360) 486-6710

525 Lilly Rd NE
Olympia, WA 98506
Phone (360) 413-8550

Interoperability endpoints

  • Direct secure messaging: lcarlson009@direct.sp-mc.org

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1260144000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623974400000",
    "number": "1568790384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3360",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972083360"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1620 COOPER POINT RD SW",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985025736",
            "telephone_number": "360-486-6710",
            "fax_number": "360-705-0269"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1217 Cooper Point Rd SW",
            "address_purpose": "LOCATION",
            "city": "Olympia",
            "state": "WA",
            "postal_code": "985027204",
            "country_code": "US",
            "telephone_number": "360-486-2900",
            "fax_number": "360-486-2970",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NOURSE",
        "first_name": "LINDSAY",
        "middle_name": "LIDIA",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-12-07",
        "last_updated": "2021-06-18",
        "certification_date": "2021-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "PA60208834",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "lnourse969129@wm.providencedirect.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1217 Cooper Point Rd SW",
            "city": "Olympia",
            "state": "WA",
            "country_code": "US",
            "postal_code": "985027204",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Olympia, WA

Sources for this page

Verify at the official NPI Registry.