Individual provider Active NPI

Dana P Jergens, PA-C

  • Surgical Physician Assistant
  • Bellevue, WA
National Provider Identifier
1760784797
Registry record updated Jul 11, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
PA60285528 Issued in WA
Practice address
1231 116TH Ave NE
Suite 750
Bellevue, WA 98004-3804
Phone
(425) 455-3600
Fax
(425) 455-3220
NPI assigned
Nov 24, 2010
Last updated
Jul 11, 2012By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 11, 2012

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 PA9105721 FL
Surgical Physician Assistant 363AS0400X PA60285528 WA Primary

Addresses

Primary practice location

1231 116TH Ave NE
Suite 750
Bellevue, WA 98004-3804

Mailing address

805 Madison St
Suite 901
Seattle, WA 98104-1172
Phone (206) 264-8100

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
I20120806000220 WA Practitioner - Physician Assistant 3476733643 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2010
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)

3101 Northup Way
Bellevue, WA 98004-1449

510 8TH Ave NE
Issaquah, WA 98029-5436

515 Minor Ave
Suite 200
Seattle, WA 98104-2133
Phone (425) 656-5060

751 NE Blakely Dr
Issaquah, WA 98029-6201
Phone (425) 313-5422

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Proliance Surgeons, Inc., P.S. CurrentSince Jul 9, 2012 Accepting new patients
Proliance Surgeons Inc P S Surgical CurrentSince Jul 9, 2012 Accepting new patients

Locations

1231 116th Ave NE
Ste 750
Bellevue, WA 98004
Phone (425) 455-3600

510 8th Ave NE
Ste 200
Issaquah, WA 98029
Phone (425) 392-3030

510 8th Ave NE
Ste 320
Issaquah, WA 98029

12911 120th Ave NE
Ste H120
Kirkland, WA 98034
Phone (425) 823-4226

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

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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": "1290556800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1341964800000",
    "number": "1760784797",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "805 MADISON ST",
            "address_2": "SUITE 901",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981041172",
            "telephone_number": "206-264-8100",
            "fax_number": "206-264-8689"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1231 116TH AVE NE",
            "address_2": "SUITE 750",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980043804",
            "telephone_number": "425-455-3600",
            "fax_number": "425-455-3220"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JERGENS",
        "first_name": "DANA",
        "middle_name": "P",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-11-24",
        "last_updated": "2012-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "FL",
            "license": "PA9105721",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "WA",
            "license": "PA60285528",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bellevue, WA

Sources for this page

Verify at the official NPI Registry.