Active NPI
Marie Antoinette Tsurgeon, PA-C
- Medical Physician Assistant
- Spanaway, WA
National Provider Identifier
1790839991
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- PA10004312
- Practice address
- 225 176TH St S
Spanaway, WA 98387-9201 - Phone
- (253) 459-7777
- NPI assigned
- Jan 23, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 004112-1 | NY | |
| Physician Assistant | 363A00000X | PA10004312 | WA | |
| Medical Physician Assistant | 363AM0700X | PA10004312 | WA | Primary |
Addresses
Primary practice location
225 176TH St S
Spanaway, WA 98387-9201
Mailing address
225 176TH St S
Spanaway, WA 98387-9201
Phone (253) 459-7777
Other names 1
- Marie Antoinette Polycarpe
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
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 004112-1 | NY | MD | Mental Health Counselor |
| 2963 | SC | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Tennessee Urgent Care Associates, LLC | Physician Assistant | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Urgent Care Clinic/Center
- Nashville, TN
- NPI 1548258825
Physician Assistant
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169510400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1433808000000",
"number": "1790839991",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "225 176TH ST S",
"city": "SPANAWAY",
"state": "WA",
"postal_code": "983879201",
"telephone_number": "253-459-7777"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "225 176TH ST S",
"city": "SPANAWAY",
"state": "WA",
"postal_code": "983879201",
"telephone_number": "253-459-7777"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TSURGEON",
"first_name": "MARIE",
"middle_name": "ANTOINETTE",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-23",
"last_updated": "2015-06-09",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NY",
"license": "004112-1",
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "WA",
"license": "PA10004312",
"primary": false
},
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "WA",
"license": "PA10004312",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "MARIE",
"last_name": "POLYCARPE",
"middle_name": "ANTOINETTE",
"credential": "PA-C",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Spanaway, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.