Individual provider Active NPI

Jean Michele C. Belista, PA-C

  • Surgical Physician Assistant
  • Puyallup, WA
National Provider Identifier
1669085726
Registry record updated Apr 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
PA61470001 Issued in WA
Practice address
3801 5TH St SE Ste 110
Puyallup, WA 98374-2106
Phone
(253) 845-9585
Fax
(253) 848-1126
NPI assigned
Aug 28, 2020
Last updated
Apr 15, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 15, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X
Surgical Physician Assistant 363AS0400X PA61470001 WA Primary

Addresses

Primary practice location

3801 5TH St SE Ste 110
Puyallup, WA 98374-2106

Mailing address

3801 5TH St SE Ste 110
Puyallup, WA 98374-2106
Phone (253) 845-9585

Other practice location 1

20920 Sr 410 E
Bonney Lake, WA 98391-6302
Phone (253) 845-9585

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240430003316 WA Practitioner - Physician Assistant 5294175824 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Proliance Surgeons Inc P SGroup PAC ID 8527972900, 395 clinicians

Practice addresses (Care Compare)

20920 State Route 410 E
Bonney Lake, WA 98391-6302
Phone (253) 845-9585

3801 5TH St SE
Puyallup, WA 98374-2106

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Proliance Surgeons Inc P S Surgical CurrentSince Apr 9, 2024 Accepting new patients
Proliance Surgeons, Inc., P.S. CurrentSince Apr 9, 2024 Accepting new patients

Locations

20920 State Route 410 E
Bonney Lake, WA 98391
Phone (253) 845-9585

3801 5th St SE
Ste 110
Puyallup, WA 98374
Phone (253) 845-9585

805 Madison St
Ste 901
Seattle, WA 98104
Phone (206) 264-8100

Interoperability endpoints

  • Direct secure messaging: jeanmichele.belista.p83@direct.proliance.nextgenshare.com

Organizations & group practices 3

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 1

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": "1598572800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713139200000",
    "number": "1669085726",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3801 5TH ST SE STE 110",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983742106",
            "telephone_number": "253-845-9585",
            "fax_number": "253-848-1126"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3801 5TH ST SE STE 110",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983742106",
            "telephone_number": "253-845-9585",
            "fax_number": "253-848-1126"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "20920 SR 410 E",
            "address_purpose": "LOCATION",
            "city": "Bonney Lake",
            "state": "WA",
            "postal_code": "983916302",
            "country_code": "US",
            "telephone_number": "253-845-9585",
            "fax_number": "253-848-1126",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BELISTA",
        "first_name": "JEAN MICHELE",
        "middle_name": "C.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-08-28",
        "last_updated": "2024-04-15",
        "certification_date": "2023-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "WA",
            "license": "PA61470001",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Puyallup, WA

Sources for this page

Verify at the official NPI Registry.