Individual provider Active NPI

John Tilley, PA-C

  • Physician Assistant
  • Everett, WA
National Provider Identifier
1730444175
Registry record updated May 6, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA60652694 Issued in WA
Practice address
900 Pacific Ave
Everett, WA 98201-4168
Phone
(425) 339-5430
Fax
(425) 339-5454
NPI assigned
Jul 11, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 6, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X PA4432 MA
Physician Assistant 363A00000X PA60652694 WA Primary

Addresses

Primary practice location

900 Pacific Ave
Everett, WA 98201-4168

Mailing address

7600 Evergreen Way
Everett, WA 98203-6421
Phone (206) 860-5414

Other practice location 1

1321 Colby Ave
Everett, WA 98201-1665
Phone (425) 261-2000

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jtilley679307@wm.providencedirect.org

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
I20160901001078 WA Practitioner - Physician Assistant 9830328863 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Optum Care Washington PLLCGroup PAC ID 6406752153, 684 clinicians

Practice addresses (Care Compare)

1321 Colby Ave
Everett, WA 98201-1665
Phone (425) 261-2000

1330 Rockefeller Ave
Everett, WA 98201-1684
Phone (425) 259-0966

3927 Rucker Ave
Everett, WA 98201-4833
Phone (425) 259-0966

4112 Harbour Pointe Blvd SW
Suite 100
Mukilteo, WA 98275-5457
Phone (425) 347-6330

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA4432MAMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Health & Services - Washington CurrentSince Oct 10, 2016 Accepting new patients
Providence Health & Services-Washington CurrentSince Oct 10, 2016 Accepting new patients
Providence Health & Services- Washington CurrentSince Oct 10, 2016 Accepting new patients
Optum Care Washington PLLC CurrentSince Jul 3, 2023 Accepting new patients
Providence Health & Services-Wa CurrentSince Oct 10, 2016 Accepting new patients
Optum Care Washington PLLC CurrentSince Jul 3, 2023 Accepting new patients
Providence Health & Services - Washington Past Accepting new patients
Optum Care Washington PLLC Past Accepting new patients

Locations

900 Pacific Ave
Everett, WA 98201
Phone (425) 258-7900

900 Pacific Ave
Fl 5
Everett, WA 98201
Phone (425) 258-7311

1700 13th St
Everett, WA 98201
Phone (425) 252-0895

1321 Colby Ave
Everett, WA 98201
Phone (425) 259-4413

1330 Rockefeller Ave
Everett, WA 98201
Phone (425) 258-3903

1321 Colby Ave
Ofc
Everett, WA 98201
Phone (425) 261-4076

4112 Harbour Pointe Blvd SW
Ste 100
Mukilteo, WA 98275
Phone (425) 347-6330

Organizations & group practices 10

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 2

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": "1341964800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1778025600000",
    "number": "1730444175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7600 EVERGREEN WAY",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982036421",
            "telephone_number": "206-860-5414"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 PACIFIC AVE",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982014168",
            "telephone_number": "425-339-5430",
            "fax_number": "425-339-5454"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1321 Colby Ave",
            "address_purpose": "LOCATION",
            "city": "Everett",
            "state": "WA",
            "postal_code": "982011665",
            "country_code": "US",
            "telephone_number": "425-261-2000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TILLEY",
        "first_name": "JOHN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-07-11",
        "last_updated": "2026-05-06",
        "certification_date": "2026-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "MA",
            "license": "PA4432",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "PA60652694",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jtilley679307@wm.providencedirect.org",
            "affiliation": "N",
            "address_1": "1700 13th St",
            "city": "Everett",
            "state": "WA",
            "country_code": "US",
            "postal_code": "982011689",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Everett, WA

Sources for this page

Verify at the official NPI Registry.