Jackson Grey Likens, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA61450103 Issued in WA

Practice address

3651 Ashworth Ave N Unit B
Seattle, WA 98103-8116

Phone

(407) 927-1656

NPI assigned

Jun 14, 2023

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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

Specialty

Physician Assistant

Education

University of Florida College of Medicine, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Pacific Northwest Medical Services PLLCGroup PAC ID 7911174453, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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.

• Pacific Northwest Medical Services PLLC

  • Urgent Care Clinic/Center
  • Kent, WA
  • NPI 1902188196
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1686700800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713916800000",
    "number": "1851075477",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18012 68TH AVE S STE 101",
            "city": "KENT",
            "state": "WA",
            "postal_code": "980321022",
            "telephone_number": "425-291-3300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3651 ASHWORTH AVE N UNIT B",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981038116",
            "telephone_number": "407-927-1656"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIKENS",
        "first_name": "JACKSON",
        "middle_name": "GREY",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-06-14",
        "last_updated": "2024-04-24",
        "certification_date": "2024-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "9116959",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "PA61450103",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kristin Lightfeather
• Lighthouse for the Blind, Inc
• Karissa Lightsmith
• Juliet Lihalakha
• Andrea Likens
• Sienna Lila, MD
• Brooke Anna Liland
• Wayne Conrad Liles Jr., MD, PHD
• Andrea Lilga-Roth, RN
• Loren Lilienthal

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2024; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.