Individual provider Active NPI

Luis Lozano, PA

  • Surgical Physician Assistant
  • Puyallup, WA
National Provider Identifier
1720066947
Registry record updated Nov 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
PA1003732 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
Jan 6, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 11, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA1003732 WA
Surgical Physician Assistant 363AS0400X PA1003732 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

Other identifiers 2

IdentifierTypeStateIssuer
500518OtherWAWA LABOR & INDUSTRIES
2025150MedicaidWA

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
I20040510001353 WA Practitioner - Physician Assistant 4880683317 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
Group practices
Proliance Surgeons Inc P SGroup PAC ID 8527972900, 395 clinicians

Practice addresses (Care Compare)

3801 5TH St SE
Puyallup, WA 98374-2106

Hospital & facility affiliations

  • Multicare Good Samaritan Hospital Hospital, Puyallup, WA, CCN 500079

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA1003732WAMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Cascade Surgery Associates, PLLC CurrentSince Jun 7, 2004 Accepting new patients
Proliance Surgeons Inc P S Surgical CurrentSince Oct 15, 2024 Accepting new patients
Proliance Surgeons, Inc., P.S. CurrentSince Oct 15, 2024 Accepting new patients
Washington Gastroenterology PLLC Past Accepting new patients

Locations

122 3rd St NE
Auburn, WA 98002
Phone (253) 833-7750

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

17700 SE 272nd St
Ste 420
Kent, WA 98042
Phone (253) 639-9660

17700 SE 272nd St
#420
Kent, WA 98042
Phone (253) 639-9660

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

4011 Talbot Rd S
Ste 300
Renton, WA 98055
Phone (206) 656-5060

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

Interoperability endpoints

  • Direct secure messaging: luis.lozano.p83@direct.proliance.nextgenshare.com

Organizations & group practices 5

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.

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": "1136505600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731283200000",
    "number": "1720066947",
    "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": "LOZANO",
        "first_name": "LUIS",
        "name_prefix": "Mr.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-06",
        "last_updated": "2024-11-11",
        "certification_date": "2024-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "WA",
            "license": "PA1003732",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "WA",
            "license": "PA1003732",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WA LABOR & INDUSTRIES",
            "identifier": "500518",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2025150",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Puyallup, WA

Sources for this page

Verify at the official NPI Registry.