Individual provider Active NPI

Lisa Marie Gail, P.A.-C

  • Physician Assistant
  • Bonney Lake, WA
National Provider Identifier
1740564798
Registry record updated May 8, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA60729786 Issued in WA
Practice address
10004 204TH Ave E
# 1200, 3400
Bonney Lake, WA 98391-6539
Phone
(253) 848-5951
Fax
(253) 845-7073
NPI assigned
Oct 7, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 8, 2017

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 PA60729786 WA Primary

Addresses

Primary practice location

10004 204TH Ave E
# 1200, 3400
Bonney Lake, WA 98391-6539

Mailing address

3908 10TH St SE
Puyallup, WA 98374-2188
Phone (253) 848-5951

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
I20170606001699 WA Practitioner - Physician Assistant 3274778683 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA60729786WAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
South Hill Family Medicine PC CurrentSince May 1, 2017 Accepting new patients

Locations

10004 204th Ave E
Ste 1200
Bonney Lake, WA 98391
Phone (253) 447-3355

611 31st Ave SW
Ste C
Puyallup, WA 98373
Phone (253) 848-5951

3908 10th St SE
Puyallup, WA 98374
Phone (253) 848-5951

Organizations & group practices 1

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1317945600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1494201600000",
    "number": "1740564798",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3908 10TH ST SE",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983742188",
            "telephone_number": "253-848-5951",
            "fax_number": "253-845-7073"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10004 204TH AVE E",
            "address_2": "# 1200, 3400",
            "city": "BONNEY LAKE",
            "state": "WA",
            "postal_code": "983916539",
            "telephone_number": "253-848-5951",
            "fax_number": "253-845-7073"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GAIL",
        "first_name": "LISA",
        "middle_name": "MARIE",
        "credential": "P.A.-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-10-07",
        "last_updated": "2017-05-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "PA60729786",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bonney Lake, WA

Sources for this page

Verify at the official NPI Registry.