Individual provider Active NPI

Peter C. Rhee, PA-C

  • Surgical Physician Assistant
  • Renton, WA
National Provider Identifier
1770715112
Registry record updated Nov 5, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
PA60188697 Issued in WA
Practice address
4011 Talbot Rd S Ste 300
Renton, WA 98055-5791
Phone
(425) 656-5060
Fax
(425) 656-5047
NPI assigned
Aug 19, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 5, 2018

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 PA60188697 WA Primary

Addresses

Primary practice location

4011 Talbot Rd S Ste 300
Renton, WA 98055-5791

Mailing address

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

Other practice location 1

24060 SE Kent Kangley Rd Ste D-100
Maple Valley, WA 98038-6801
Phone (425) 358-7708

Other practice location 2

27005 168th Pl SE Ste 201
Covington, WA 98042-4902
Phone (253) 630-3660

Other identifiers 1

IdentifierTypeStateIssuer
2107845MedicaidWA

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
I20110118000585 WA Practitioner - Physician Assistant 0446399562 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2009
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)

150 Andover Park W
Tukwila, WA 98188-2801
Phone (425) 979-2663

1620 Lake Tapps Pkwy SE
Suite 115
Auburn, WA 98092-8376
Phone (253) 246-2860

24060 SE Kent Kangley Rd
Maple Valley, WA 98038-6801
Phone (425) 656-5060

27005 168TH PL SE
Suite 201
Covington, WA 98042-4902
Phone (253) 630-3660

4011 Talbot Rd S
Suite 300
Renton, WA 98055-5791
Phone (206) 656-5060

Hospital & facility affiliations

  • Valley Medical Center Hospital, Renton, WA, CCN 500088

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA60188697WAMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Proliance Surgeons Inc P S Physician Assistant CurrentSince Oct 12, 2018 Accepting new patients
Proliance Surgeons Inc., P.S. Surgical Current Accepting new patients
Proliance Surgeons Inc P S Surgical CurrentSince Oct 12, 2018 Accepting new patients
Lumincare Physician Group, PA Past Accepting new patients

Locations

27005 168th Pl SE
#201
Covington, WA 98042
Phone (253) 630-3660

24060 SE Kent Kangley Rd
#D100
Maple Valley, WA 98038
Phone (425) 358-7708

4011 Talbot Rd S
Ste 300
Renton, WA 98055
Phone (206) 656-5060

801 Broadway
Ste 617
Seattle, WA 98122
Phone (206) 623-0922

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

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 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": "1250640000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1541376000000",
    "number": "1770715112",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4011 TALBOT RD S STE 300",
            "city": "RENTON",
            "state": "WA",
            "postal_code": "980555791",
            "telephone_number": "425-656-5060",
            "fax_number": "425-656-5047"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "24060 SE Kent Kangley Rd Ste D-100",
            "address_purpose": "LOCATION",
            "city": "Maple Valley",
            "state": "WA",
            "postal_code": "980386801",
            "country_code": "US",
            "telephone_number": "425-358-7708",
            "fax_number": "425-656-5047",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "27005 168th Pl SE Ste 201",
            "address_purpose": "LOCATION",
            "city": "Covington",
            "state": "WA",
            "postal_code": "980424902",
            "country_code": "US",
            "telephone_number": "253-630-3660",
            "fax_number": "253-631-1591",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RHEE",
        "first_name": "PETER",
        "middle_name": "C.",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-08-19",
        "last_updated": "2018-11-05",
        "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": "PA60188697",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2107845",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Renton, WA

Sources for this page

Verify at the official NPI Registry.