Active NPI
Stacia Reagan, PA-C, OSTEOPATHIC PA
- Physical Medicine & Rehabilitation Physician
- Spokane, WA
National Provider Identifier
1659729093
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Medicine & Rehabilitation Physician
- License
- OA60801269
- Practice address
- 124 E Rowan Ave Ste 101
Spokane, WA 99207-1214 - Phone
- (509) 487-6222
- NPI assigned
- May 26, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA60790383 | WA | |
| Physical Medicine & Rehabilitation Physician | 208100000X | OA60801269 | WA | Primary |
Addresses
Primary practice location
124 E Rowan Ave Ste 101
Spokane, WA 99207-1214
Mailing address
124 E Rowan Ave Ste 202
Spokane, WA 99207-1214
Phone (509) 487-8000
Other practice location 1
PO Box 458
Cheney, WA 99004-0458
Phone (509) 280-6122
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OA60801269 | WA | MD | Physical Medicine & Rehabilitation Physician |
Organizations & group practices 1
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.
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- Graham, WA
- NPI 1679264485
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1464220800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1589500800000",
"number": "1659729093",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "124 E ROWAN AVE STE 202",
"city": "SPOKANE",
"state": "WA",
"postal_code": "992071214",
"telephone_number": "509-487-8000",
"fax_number": "509-487-6333"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "124 E ROWAN AVE STE 101",
"city": "SPOKANE",
"state": "WA",
"postal_code": "992071214",
"telephone_number": "509-487-6222"
}
],
"practiceLocations": [
{
"address_1": "PO Box 458",
"address_purpose": "LOCATION",
"city": "Cheney",
"state": "WA",
"postal_code": "990040458",
"country_code": "US",
"telephone_number": "509-280-6122",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "REAGAN",
"first_name": "STACIA",
"name_prefix": "Mrs.",
"credential": "PA-C, OSTEOPATHIC PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-05-26",
"last_updated": "2020-05-15",
"certification_date": "2020-05-15",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "WA",
"license": "PA60790383",
"primary": false
},
{
"code": "208100000X",
"taxonomy_group": "",
"desc": "Physical Medicine & Rehabilitation",
"state": "WA",
"license": "OA60801269",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Spokane, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2020; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.