NPIMap

Individual provider Active NPI

Michael K Cavanagh, PA-C

  • Physician Assistant
  • Tacoma, WA
National Provider Identifier
1770529406
Registry record updated Dec 2, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA10003792 Issued in WA
Practice address
1802 Yakima Ave Ste 102
Tacoma, WA 98405-5303
Phone
(253) 272-7777
NPI assigned
Jun 21, 2006
Last updated
Dec 2, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 2, 2020

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 PA10003792 WA Primary
Surgical Physician Assistant 363AS0400X PA10003792 WA

Addresses

Primary practice location

1802 Yakima Ave Ste 102
Tacoma, WA 98405-5303

Mailing address

1802 Yakima Ave Ste 102
Tacoma, WA 98405-5303
Phone (253) 272-7777

Other identifiers 5

IdentifierTypeStateIssuer
0127008OtherWASTATE L&I
P00220038OtherWAMEDICARE RAILROAD
1045595MedicaidWA
8403339MedicaidWA
8926049OtherWACRIME VICTIMS

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mcavanagh21909@fhsce.catholichealth.net Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050912000894 WA Practitioner - Physician Assistant 2860425741 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1983
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Franciscan Medical GroupGroup PAC ID 0547173866, 1,400 clinicians

Practice addresses (Care Compare)

1717 S J St
Tacoma, WA 98405-4933
Phone (253) 426-6341

1812 S J St
Suite 120
Tacoma, WA 98405-4965
Phone (253) 428-2200

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA10003792WAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Franciscan Medical Group CurrentSince Feb 1, 2014 Accepting new patients
Franciscan Health System Past Accepting new patients
Commonspirit Washington Past Accepting new patients
Franciscan Medical Group Physician Assistant Past Accepting new patients
Commonspirit Washington Past Accepting new patients

Locations

1708 Yakima Ave
Ste 107
Tacoma, WA 98405
Phone (253) 207-4850

1717 S J St
Tacoma, WA 98405
Phone (253) 426-4101

Interoperability endpoints

  • Direct secure messaging: mcavanagh21909@fhsce.catholichealth.net

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, 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": "1150848000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606867200000",
    "number": "1770529406",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1802 YAKIMA AVE STE 102",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984055303",
            "telephone_number": "253-272-7777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1802 YAKIMA AVE STE 102",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984055303",
            "telephone_number": "253-272-7777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CAVANAGH",
        "first_name": "MICHAEL",
        "middle_name": "K",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-21",
        "last_updated": "2020-12-02",
        "certification_date": "2020-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "PA10003792",
            "primary": true
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "WA",
            "license": "PA10003792",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE L&I",
            "identifier": "0127008",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "P00220038",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1045595",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8403339",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CRIME VICTIMS",
            "identifier": "8926049",
            "state": "WA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mcavanagh21909@fhsce.catholichealth.net",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1802 Yakima Ave Ste 102",
            "city": "Tacoma",
            "state": "WA",
            "country_code": "US",
            "postal_code": "984055303",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Tacoma, WA

Sources for this page

Verify at the official NPI Registry.