Active NPI
Andrea Alys Burgess, PA-C
- Surgical Physician Assistant
- Seattle, WA
National Provider Identifier
1831557107
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Physician Assistant
- License
- PA60800587
- Practice address
- 600 Broadway Swedish Maxillofacial Surgery
Suite 460
Seattle, WA 98122 - Phone
- (206) 320-2078
- Fax
- (206) 386-3296
- NPI assigned
- Feb 2, 2016
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | |||
| Surgical Physician Assistant | 363AS0400X | PA60800587 | WA | Primary |
Addresses
Primary practice location
600 Broadway Swedish Maxillofacial Surgery
Suite 460
Seattle, WA 98122
Mailing address
600 Broadway
Suite 460
Seattle, WA 98122
Phone (206) 320-2078
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831557107 | Medicaid | WA |
Other names 1
- Ms. Andrea Alys Kerrigan
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 |
|---|---|---|---|
| PA60800587 | WA | MD | Surgical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Samuel Bobek PLLC | Surgical | 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 and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1454371200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1532476800000",
"number": "1831557107",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "600 BROADWAY",
"address_2": "SUITE 460",
"city": "SEATTLE",
"state": "WA",
"postal_code": "98122",
"telephone_number": "206-320-2078"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "600 BROADWAY SWEDISH MAXILLOFACIAL SURGERY",
"address_2": "SUITE 460",
"city": "SEATTLE",
"state": "WA",
"postal_code": "98122",
"telephone_number": "206-320-2078",
"fax_number": "206-386-3296"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BURGESS",
"first_name": "ANDREA",
"middle_name": "ALYS",
"name_prefix": "Mrs.",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-02-02",
"last_updated": "2018-07-25",
"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": "PA60800587",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1831557107",
"state": "WA"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "ANDREA",
"last_name": "KERRIGAN",
"middle_name": "ALYS",
"prefix": "MS.",
"credential": "PA-C",
"code": "1",
"type": "Former Name"
}
]
}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 Jul 25, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.