Abraham G Abu, PA-C
Individual provider Active NPI Physician Assistant · Seattle, WA
NPI 1710036587 · NPPES record last updated Oct 24, 2016
Key facts
- NPI
- 1710036587
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- PA10004262 (WA)
- Practice address
- 550 17TH Ave
5TH FL
Seattle, WA 98122-5788 - Phone
- (206) 386-3880
- Fax
- (206) 386-3882
- NPI assigned
- Jan 9, 2007
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 10
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2001
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Kaiser Foundation Health Plan of the Northwest
Practice addresses (Care Compare)
10100 SE Sunnyside Rd
Clackamas, OR 97015-8970
Phone (800) 813-2000
10180 SE Sunnyside Rd
Clackamas, OR 97015-8970
Phone (800) 813-2000
3600 N Interstate Ave
Portland, OR 97227-1106
Phone (800) 813-2000
3620 N Interstate Ave
Portland, OR 97227-1106
Phone (800) 813-2000
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in OR, WA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050311000952 | OR | Practitioner - Physician Assistant | 2365497351 | Reassigns benefits to 2 organizations |
| I20080310000332 | WA | Practitioner - Physician Assistant | 2365497351 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Peacehealth Medical Group | Current |
Accepting new patients | |
| Kaiser Foundation Health Plan of the Northwest | Current |
Accepting new patients | |
| Manor Care of Salmon Creek Wa, Association | Current |
Accepting new patients | |
| Kaiser Foundation Health Plan of the Northwest | Current |
Accepting new patients | |
| Advanced Pain Management Center | Past | Accepting new patients |
Locations
10100 SE Sunnyside Rd
Clackamas, OR 97015
Phone (503) 571-2946
4010 Aerial Way
Eugene, OR 97402
Phone (541) 242-8300
7201 N Interstate Ave
Portland, OR 97217
Phone (503) 240-4051
2400 Lancaster Dr NE
Salem, OR 97305
Phone (503) 361-5400
1230 7th Ave
Longview, WA 98632
Phone (360) 575-4801
1615 Delaware St
Longview, WA 98632
Phone (360) 363-4818
7101 NE 137th Ave
Vancouver, WA 98682
Phone (360) 418-6000
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 11053 | MN | |
| Physician Assistant | 363A00000X | PA10004262 | WA | Yes |
Addresses
Primary practice location
550 17TH Ave
5TH FL
Seattle, WA 98122-5788
Mailing address
PO Box 25608
Salt Lake City, UT 84125-0608
Phone (206) 320-4476
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8504441 | Medicaid | WA | |
| 0229007 | Other | WA | LABOR & INDUSTRIES |
| 50060526 | Medicaid | OR |
Other providers in Seattle, WA
- Kaska Dominic Abron
- Absolute Chiropractic and Wellness Center, Inc
- Kim Gittere Abson
- Abu & del Rosario, PLLC
- Ali Abu-Alya
- Hani Abuassi
- Seja Abudiab
- Michaela Abueg
- Somaya Abdelhaim Abuelazm
- Anisa Abukar
All providers in Seattle, WA · Physician Assistant in Washington
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 24, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.