Individual provider Active NPI

Patricia C Reppar, PA-C

  • Surgical Physician Assistant
  • Kirkland, WA
National Provider Identifier
1720555345
Registry record updated Feb 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
PA60933978 Issued in WA
Practice address
12911 120TH Ave NE Ste H210
Kirkland, WA 98034-3065
Phone
(425) 823-4000
Fax
(425) 821-3550
NPI assigned
Nov 1, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 20, 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 PA60933978 WA Primary

Addresses

Primary practice location

12911 120TH Ave NE Ste H210
Kirkland, WA 98034-3065

Mailing address

12911 120TH Ave NE Ste G10
Kirkland, WA 98034-3048
Phone (425) 823-4000

Other practice location 1

901 Boren Ave Ste 711
Seattle, WA 98104-3301
Phone (425) 823-4000

Other identifiers 1

IdentifierTypeStateIssuer
2128548MedicaidWA

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
I20190521002231 WA Practitioner - Physician Assistant 0244573947 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Proliance Surgeons Inc P SGroup PAC ID 8527972900, 395 clinicians

Practice addresses (Care Compare)

12911 120TH Ave NE
Suite H210
Kirkland, WA 98034-3065
Phone (425) 823-4000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA60933978WAMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Harborview Medical Center CurrentSince May 1, 2019 Accepting new patients
Proliance Surgeons Inc P S Surgical CurrentSince Feb 13, 2024 Accepting new patients
Proliance Surgeons Inc P S Surgical CurrentSince Feb 13, 2024 Accepting new patients
Harborview Medical Center CurrentSince May 1, 2019 Accepting new patients

Locations

12911 120th Ave NE
Ste G10
Kirkland, WA 98034
Phone (425) 481-6301

12911 120th Ave NE
Ste H210
Kirkland, WA 98034
Phone (425) 823-4000

901 Boren Ave
Ste 711
Seattle, WA 98104
Phone (206) 257-3350

325 9th Ave
Seattle, WA 98104
Phone (206) 731-3000

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

1959 NE Pacific St
Seattle, WA 98195
Phone (206) 598-4333

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 3

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": "1541030400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708387200000",
    "number": "1720555345",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12911 120TH AVE NE STE G10",
            "city": "KIRKLAND",
            "state": "WA",
            "postal_code": "980343048",
            "telephone_number": "425-823-4000",
            "fax_number": "425-821-3550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12911 120TH AVE NE STE H210",
            "city": "KIRKLAND",
            "state": "WA",
            "postal_code": "980343065",
            "telephone_number": "425-823-4000",
            "fax_number": "425-821-3550"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "901 Boren Ave Ste 711",
            "address_purpose": "LOCATION",
            "city": "Seattle",
            "state": "WA",
            "postal_code": "981043301",
            "country_code": "US",
            "telephone_number": "425-823-4000",
            "fax_number": "206-323-6868",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "REPPAR",
        "first_name": "PATRICIA",
        "middle_name": "C",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-11-01",
        "last_updated": "2024-02-20",
        "certification_date": "2024-02-20",
        "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": "PA60933978",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2128548",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kirkland, WA

Sources for this page

Verify at the official NPI Registry.