NPIMap

Individual provider Active NPI

Mary Lou Pine, PA-C

  • Physician Assistant
  • Sunnyside, WA
National Provider Identifier
1649388588
Registry record updated Sep 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA10004660 Issued in WA
Practice address
700 S 11TH St
Sunnyside, WA 98944-2243
Phone
(509) 839-6822
NPI assigned
Aug 29, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 17, 2018

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 PA10004660 WA Primary

Addresses

Primary practice location

700 S 11TH St
Sunnyside, WA 98944-2243

Mailing address

203 SW Malibu Drive
Prosser, WA 99350

Other identifiers 1

IdentifierTypeStateIssuer
8541989MedicaidWA

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
I20090120000112 WA Practitioner - Physician Assistant 9830128966 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Pine Family Practice LLCGroup PAC ID 1759625130, 2 clinicians

Practice addresses (Care Compare)

2240 E Lincoln Ave
Sunnyside, WA 98944-2487
Phone (509) 836-2367

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
83.73 of 100Reported as group
Quality
80.23
Promoting interoperability
82
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA10004660WAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Columbia Valley Emergency Physicians LLC Physician Assistant Past Accepting new patients
Washington Em-I Medical Services PC Physician Assistant Past Accepting new patients
BD Sunnyside I, LLC Past Accepting new patients
Wabash Em I Medical Services PC Physician Assistant Past Accepting new patients
Mid State Logansport Ed Physicians Past Accepting new patients

Organizations & group practices 6

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.

Hospital & facility affiliations 2

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": "1156809600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1537142400000",
    "number": "1649388588",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "203 SW MALIBU DRIVE",
            "city": "PROSSER",
            "state": "WA",
            "postal_code": "99350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 S 11TH ST",
            "city": "SUNNYSIDE",
            "state": "WA",
            "postal_code": "989442243",
            "telephone_number": "509-839-6822"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PINE",
        "first_name": "MARY",
        "middle_name": "LOU",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-08-29",
        "last_updated": "2018-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "PA10004660",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8541989",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sunnyside, WA

Sources for this page

Verify at the official NPI Registry.