NPIMap

Individual provider Active NPI

Lazia Van Wieringen, PA-C

  • Medical Physician Assistant
  • Mount Vernon, WA
National Provider Identifier
1871114645
Registry record updated Dec 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA61187952 Issued in WA
Practice address
2320 Freeway Dr
Mount Vernon, WA 98273-5445
Phone
(360) 428-2550
Fax
(360) 428-6402
NPI assigned
May 2, 2020
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 30, 2024

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 PA.PA.61187952 WA
Medical Physician Assistant 363AM0700X PA61187952 WA Primary

Addresses

Primary practice location

2320 Freeway Dr
Mount Vernon, WA 98273-5445

Mailing address

910 Gladstone St Apt 111
Bellingham, WA 98229-6226
Phone (425) 367-9015

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address lvanwieringen61675@skagit.direct-ci.com Direct

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
I20210921001013 WA Practitioner - Physician Assistant 5799182655 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Public Hospital Dist No 1 SkagitGroup PAC ID 6800793522, 321 clinicians

Practice addresses (Care Compare)

1400 E Kincaid St
Mount Vernon, WA 98274-4127
Phone (360) 428-2500

2320 Fwy Dr
Mount Vernon, WA 98273-5445
Phone (360) 814-6800

Hospital & facility affiliations

  • Skagit Valley Hospital Hospital, Mount Vernon, WA, CCN 500003
  • Peacehealth United General Medical Center Hospital, Sedro Woolley, WA, CCN 501329
  • Whidbeyhealth Medical Center Hospital, Coupeville, WA, CCN 501339
  • Island Hospital Hospital, Anacortes, WA, CCN 500007

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA.PA.61187952WAMDPhysician Assistant
PA61187952WAMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Public Hospital Dist No 1 Skagit CurrentSince Dec 16, 2024 Accepting new patients
Public Hospital Dist No 1 Skagit Past Accepting new patients

Locations

2320 Freeway Dr
Mount Vernon, WA 98273
Phone (360) 814-6800

1400 E Kincaid St
Mount Vernon, WA 98274
Phone (360) 428-2586

Interoperability endpoints

  • Direct secure messaging: lvanwieringen61675@skagit.direct-ci.com

Organizations & group practices 3

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 9

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": "1588377600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1735516800000",
    "number": "1871114645",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "910 GLADSTONE ST APT 111",
            "city": "BELLINGHAM",
            "state": "WA",
            "postal_code": "982296226",
            "telephone_number": "425-367-9015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2320 FREEWAY DR",
            "city": "MOUNT VERNON",
            "state": "WA",
            "postal_code": "982735445",
            "telephone_number": "360-428-2550",
            "fax_number": "360-428-6402"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAN WIERINGEN",
        "first_name": "LAZIA",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-05-02",
        "last_updated": "2024-12-30",
        "certification_date": "2024-12-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "PA.PA.61187952",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "WA",
            "license": "PA61187952",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "lvanwieringen61675@skagit.direct-ci.com",
            "affiliation": "N",
            "endpointDescription": "Provider Direct Message",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "2320 Freeway Dr",
            "city": "Mount Vernon",
            "state": "WA",
            "country_code": "US",
            "postal_code": "982735445",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Mount Vernon, WA

Sources for this page

Verify at the official NPI Registry.