Individual provider Active NPI

Shauna M Riley, PA-C

  • Surgical Physician Assistant
  • Everett, WA
National Provider Identifier
1871629709
Registry record updated Jun 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
PA10004765 Issued in WA
Practice address
1321 Colby Ave
Everett, WA 98201-1665
Phone
(425) 261-2000
NPI assigned
Feb 26, 2007
Last updated
Jun 22, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 22, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA10004765 WA
Surgical Physician Assistant 363AS0400X PA10004765 WA Primary

Addresses

Primary practice location

1321 Colby Ave
Everett, WA 98201-1665

Mailing address

PO Box 3360
Portland, OR 97208-3360
Phone (866) 747-2455

Other practice location 1

1330 Rockefeller Ave Ste 310
Everett, WA 98201-1677
Phone (425) 297-5330

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address sriley563471@wm.providencedirect.org Direct

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20050709000023 WA Practitioner - Physician Assistant 2961438221 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Overlake Medical Clinics LLCGroup PAC ID 7012808827, 423 clinicians

Practice addresses (Care Compare)

1035 116TH Ave NE
Bellevue, WA 98004-4604
Phone (425) 688-5072

1750 112TH Ave NE
Suite B102
Bellevue, WA 98004-3772
Phone (425) 688-5460

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Health & Services- Washington CurrentSince Dec 15, 2015 Accepting new patients
Providence Health & Services-Washington CurrentSince Jul 31, 2016 Accepting new patients
Providence Health & Services-Wa CurrentSince Jul 31, 2016 Accepting new patients
Overlake Medical Clinics LLC CurrentSince Sep 14, 2020 Accepting new patients
Providence Health & Services - Washington CurrentSince Dec 15, 2015 Accepting new patients
Pacific Gynecology Specialists, PC Past Accepting new patients
Pacific Gynecology Specialists, PC Past Accepting new patients
Northwest First Assists Medical Past Accepting new patients

Locations

1135 116th Ave NE
Ste 200
Bellevue, WA 98004
Phone (425) 635-3400

1750 112th Ave NE
Ste B102
Bellevue, WA 98004
Phone (425) 688-5460

1321 Colby Ave
Everett, WA 98201
Phone (425) 259-4413

1330 Rockefeller Ave
Ste 310
Everett, WA 98201
Phone (425) 261-4925

900 Pacific Ave
Fl 5
Everett, WA 98201
Phone (425) 258-7311

4112 Harbour Pointe Blvd SW
Ste 100
Mukilteo, WA 98275
Phone (425) 347-6330

Interoperability endpoints

  • Direct secure messaging: sriley563471@wm.providencedirect.org

Organizations & group practices 10

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.

Hospital & facility affiliations 2

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": "1172448000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624320000000",
    "number": "1871629709",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3360",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972083360",
            "telephone_number": "866-747-2455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1321 COLBY AVE",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982011665",
            "telephone_number": "425-261-2000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1330 Rockefeller Ave Ste 310",
            "address_purpose": "LOCATION",
            "city": "Everett",
            "state": "WA",
            "postal_code": "982011677",
            "country_code": "US",
            "telephone_number": "425-297-5330",
            "fax_number": "425-259-8600",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RILEY",
        "first_name": "SHAUNA",
        "middle_name": "M",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-26",
        "last_updated": "2021-06-22",
        "certification_date": "2021-06-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "WA",
            "license": "PA10004765",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "WA",
            "license": "PA10004765",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "sriley563471@wm.providencedirect.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1330 Rockefeller Ave Ste 310",
            "city": "Everett",
            "state": "WA",
            "country_code": "US",
            "postal_code": "982011677",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Everett, WA

Sources for this page

Verify at the official NPI Registry.