Individual provider Active NPI

Shu-Tsui Lan, PA

  • Medical Physician Assistant
  • Seattle, WA
National Provider Identifier
1770790602
Registry record updated May 12, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA60225033 Issued in WA
Practice address
1660 S Columbian Way
Seattle, WA 98108-1532
Phone
(206) 466-7237
NPI assigned
May 17, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 12, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 004270 GA
Anesthesiologist Assistant 367H00000X 004270 GA
Medical Physician Assistant 363AM0700X PA60225033 WA Primary

Addresses

Primary practice location

1660 S Columbian Way
Seattle, WA 98108-1532

Mailing address

833 Lake Washington Blvd S
Seattle, WA 98144-3311
Phone (404) 317-3551

Other practice location 1

1805 Parke Plaza Cir
Suite 103
Stone Mountain, GA 30087-3498
Phone (770) 498-9355 ext. 15

Other practice location 2

1116 Summit Ave
Seattle, WA 98101-2831
Phone (206) 323-0930 ext. 1218

Other practice location 3

1660 S Columbian Way
Seattle, WA 98108-1532
Phone (206) 466-7237

Other identifiers 1

IdentifierTypeStateIssuer
406915721AMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Associate of Arts, Physician Assistant

State licenses

LicenseStateTypeSpecialty
004270GAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Northlake Pediatric Associates,PC Past Accepting new patients
Apollomd Group Services LLC Past Accepting new patients
Northlake Anesthesia Professionals, LLC Past Accepting new patients

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1179360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620777600000",
    "number": "1770790602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "833 LAKE WASHINGTON BLVD S",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981443311",
            "telephone_number": "404-317-3551"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1660 S COLUMBIAN WAY",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981081532",
            "telephone_number": "206-466-7237"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1805 Parke Plaza Cir",
            "address_2": "Suite 103",
            "address_purpose": "LOCATION",
            "city": "Stone Mountain",
            "state": "GA",
            "postal_code": "300873498",
            "country_code": "US",
            "telephone_number": "770-498-9355 x15",
            "fax_number": "770-498-6294",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1116 Summit Ave",
            "address_purpose": "LOCATION",
            "city": "Seattle",
            "state": "WA",
            "postal_code": "981012831",
            "country_code": "US",
            "telephone_number": "206-323-0930 x1218",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1660 S Columbian Way",
            "address_purpose": "LOCATION",
            "city": "Seattle",
            "state": "WA",
            "postal_code": "981081532",
            "country_code": "US",
            "telephone_number": "206-466-7237",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LAN",
        "first_name": "SHU-TSUI",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-17",
        "last_updated": "2021-05-12",
        "certification_date": "2021-05-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "004270",
            "primary": false
        },
        {
            "code": "367H00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiologist Assistant",
            "state": "GA",
            "license": "004270",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "WA",
            "license": "PA60225033",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "406915721A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Seattle, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.