NPIMap

Individual provider Active NPI

Carrie Ann Smith, PA-C

  • Medical Physician Assistant
  • Everett, WA
National Provider Identifier
1801461132
Registry record updated Oct 4, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA61175602 Issued in WA
Practice address
916 Pacific Ave
Everett, WA 98201-4147
Phone
(425) 261-2000
Fax
(425) 404-5497
NPI assigned
May 20, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 4, 2021

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
Medical Physician Assistant 363AM0700X PA61175602 WA Primary

Addresses

Primary practice location

916 Pacific Ave
Everett, WA 98201-4147

Mailing address

19020 33Rd Ave W
Ste 210
Lynnwood, WA 98036-4748
Phone (425) 563-1500

Other identifiers 1

IdentifierTypeStateIssuer
2183553MedicaidWA

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
I20210914003061 WA Practitioner - Physician Assistant 6800292913 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Radia Inc P SGroup PAC ID 9931012812, 275 clinicians

Practice addresses (Care Compare)

12040 NE 128TH St
Kirkland, WA 98034-3013
Phone (425) 899-1800

1321 Colby Ave
Everett, WA 98201-1665
Phone (425) 261-4100

21601 76TH Ave W
Edmonds, WA 98026-7507
Phone (425) 563-1500

500 17TH Ave
Seattle, WA 98122-5711
Phone (206) 320-3700

Hospital & facility affiliations

  • Providence Regional Medical Center Everett Hospital, Everett, WA, CCN 500014
  • Swedish Edmonds Hospital Hospital, Edmonds, WA, CCN 500026
  • Evergreenhealth Medical Center Hospital, Kirkland, WA, CCN 500124
  • Swedish Medical Center Hospital, Seattle, WA, CCN 500027

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA61175602WAMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Proliance Surgeons, Inc., P.S. CurrentSince Apr 18, 2022 Accepting new patients
Proliance Surgeons Inc P S CurrentSince Apr 18, 2022 Accepting new patients
Radia Imaging Center Holdings LLC CurrentSince Oct 1, 2021 Accepting new patients

Locations

1100 Pacific Ave
Ste 300
Everett, WA 98201
Phone (425) 337-7000

19020 33rd Ave W
Ste 210
Lynnwood, WA 98036
Phone 42556315001

1025 153rd St SE
Ste 200
Mill Creek, WA 98012
Phone (425) 338-4000

601 Broadway
Fl 6
Seattle, WA 98122
Phone (206) 633-8100

900 Terry Ave
Ste 100
Seattle, WA 98104
Phone (206) 694-6665

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

1229 Madison St
Ste 900
Seattle, WA 98104
Phone (206) 292-6233

4816 NE Thurston Way
Ste A
Vancouver, WA 98662
Phone (360) 254-4914

Organizations & group practices 8

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 6

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": "1621468800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633305600000",
    "number": "1801461132",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19020 33RD AVE W",
            "address_2": "STE 210",
            "city": "LYNNWOOD",
            "state": "WA",
            "postal_code": "980364748",
            "telephone_number": "425-563-1500",
            "fax_number": "425-563-1374"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "916 PACIFIC AVE",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982014147",
            "telephone_number": "425-261-2000",
            "fax_number": "425-404-5497"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "CARRIE",
        "middle_name": "ANN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-05-20",
        "last_updated": "2021-10-04",
        "certification_date": "2021-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "WA",
            "license": "PA61175602",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2183553",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Everett, WA

Sources for this page

Verify at the official NPI Registry.