Susan M Sanborn, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA10002391 Issued in WA

Practice address

3021 Griffin Ave
Enumclaw, WA 98022-2369

Phone

(360) 825-6511

Fax

(360) 825-6536

NPI assigned

Jul 31, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 4

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• Franciscan Medical Group

  • Orthopaedic Surgery Physician
  • Silverdale, WA
  • NPI 1093165334
  Medicare reassignment
• Franciscan Medical Group

  • Neurological Surgery Physician
  • Federal Way, WA
  • NPI 1386857530
  NPD (past)

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

{
    "created_epoch": "1154304000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1289952000000",
    "number": "1790790137",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3021 GRIFFIN AVE",
            "city": "ENUMCLAW",
            "state": "WA",
            "postal_code": "980222369",
            "telephone_number": "360-825-6511",
            "fax_number": "360-825-6536"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3021 GRIFFIN AVE",
            "city": "ENUMCLAW",
            "state": "WA",
            "postal_code": "980222369",
            "telephone_number": "360-825-6511",
            "fax_number": "360-825-6536"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SANBORN",
        "first_name": "SUSAN",
        "middle_name": "M",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-31",
        "last_updated": "2010-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "PA10002391",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE L&I",
            "identifier": "0131056",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8370843",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE CRIME VICTIMS",
            "identifier": "8929994",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "97008681",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alexis Rossi
• Ryning and McGonegle DDS PLLC
• Daniel Ryning
• Safeway Inc
• Hollyanne Samuelsen, MA, BCTMB
• Kari Schamel, CMA, LMP
• Leslie Schear, ARNP CNM
• Adrianna Rae Schipper
• Nolan Nicholas Schmitt, DPT
• Ernest Emmett Scholl

• Physician Assistant in Enumclaw, WA
• Providers in Enumclaw, WA by specialty
• Physician Assistant in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.