NPIMap

Individual provider Active NPI

Jacob John Massarelli, PA-C

  • Physician Assistant
  • Centralia, WA
National Provider Identifier
1699458927
Registry record updated Oct 19, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA61478292 Issued in WA
Practice address
1800 Cooks Hill Rd Ste F
Centralia, WA 98531-9162
Phone
(360) 669-0335
Fax
(360) 736-2967
NPI assigned
Aug 11, 2023
Last updated
Oct 19, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 19, 2023

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 PA61478292 WA Primary

Addresses

Primary practice location

1800 Cooks Hill Rd Ste F
Centralia, WA 98531-9162

Mailing address

2690 NE Kresky Ave
Chehalis, WA 98532-2412
Phone (360) 330-9595

Other identifiers 1

IdentifierTypeStateIssuer
2261548MedicaidWA

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
I20231213003395 WA Practitioner - Physician Assistant 9436508645 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

117 Ramsey Way
Valley View Toledo
Toledo, WA 98591-9900
Phone (360) 864-4400

1800 Cooks Hill Rd
Centralia, WA 98531-9162

2690 NE Kresky Ave
Chehalis, WA 98532-2412
Phone (360) 330-9595

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Lewis County Community Health Services CurrentSince Nov 13, 2023 Accepting new patients
Lewis County Community Health Services CurrentSince Nov 13, 2023 Accepting new patients
Lewis County Community Health Services Past Accepting new patients

Locations

1800 Cooks Hill Rd
Ste F
Centralia, WA 98531
Phone (360) 330-8939

1800 Cooks Hill Rd
Ste G
Centralia, WA 98531
Phone (360) 736-3042

2690 NE Kresky Ave
Chehalis, WA 98532
Phone (360) 330-9595

Interoperability endpoints

  • Direct secure messaging: jacob.massarellipac.p1@direct.valleyviewhc.nextgenshare.com

Organizations & group practices 4

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 5

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": "1691712000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697673600000",
    "number": "1699458927",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2690 NE KRESKY AVE",
            "city": "CHEHALIS",
            "state": "WA",
            "postal_code": "985322412",
            "telephone_number": "360-330-9595",
            "fax_number": "360-330-9560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1800 COOKS HILL RD STE F",
            "city": "CENTRALIA",
            "state": "WA",
            "postal_code": "985319162",
            "telephone_number": "360-669-0335",
            "fax_number": "360-736-2967"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MASSARELLI",
        "first_name": "JACOB",
        "middle_name": "JOHN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-08-11",
        "last_updated": "2023-10-19",
        "certification_date": "2023-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "PA61478292",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2261548",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Centralia, WA

Sources for this page

Verify at the official NPI Registry.