Alan K Mirly, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA60997082 Issued in WA

Practice address

2525 NE 139TH St Ste 220
Vancouver, WA 98686-2719

Phone

(360) 882-2778

Fax

(360) 604-1616

NPI assigned

Sep 19, 2005

Last updated

Dec 9, 2019By the provider in NPPES

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

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in ID, WA2 enrollments

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 2

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

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.

• The Vancouver Clinic Inc PS

  dba The Vancouver Clinic

  • Internal Medicine Physician
  • Vancouver, WA
  • NPI 1992759427
  Medicare reassignment NPD (past)
• Sterling Provider Group

  • Urgent Care Clinic/Center
  • Idaho Falls, ID
  • NPI 1205300407
  Medicare reassignment
• The Vancouver Clinic Inc PS

  dba Salmon Creek 2 Ambulatory Surgery Center

  • Ambulatory Surgical Clinic/Center
  • Vancouver, WA
  • NPI 1306556907
  NPD
• The Vancouver Clinic Inc PS

  • Eyewear Supplier
  • Ridgefield, WA
  • NPI 1760004477
  NPD
• Urgent Care Associates PLLC

  • Preferred Provider Organization
  • Idaho Falls, ID
  • NPI 1609046408
  NPD
• Cape Neurological Surgeons, P. C.

  • Specialist
  • Cape Girardeau, MO
  • NPI 1629176664
  NPD (past)
• MV Pocatello ENT, LLC

  • Otolaryngology Physician
  • Pocatello, ID
  • NPI 1154801595
  NPD (past)
• Steelhead Medical LTD

  dba Kraig C McGee MD

  • Otolaryngology Physician
  • Pocatello, ID
  • NPI 1114091220
  NPD (past)

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

{
    "created_epoch": "1127088000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1575849600000",
    "number": "1891780524",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4825",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972084825",
            "telephone_number": "360-882-2778",
            "fax_number": "360-604-1771"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2525 NE 139TH ST STE 220",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986862719",
            "telephone_number": "360-882-2778",
            "fax_number": "360-604-1616"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIRLY",
        "first_name": "ALAN",
        "middle_name": "K",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-19",
        "last_updated": "2019-12-09",
        "certification_date": "2019-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ID",
            "license": "PA-558",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "PA60997082",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2143194",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "807225300",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "PAWV4",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Thomas Kelly Livingston Mirchel, DDS,MD
• Nathan Mireles
• Miriam Erickson, PH.D., PS
• Anthony A. Miriello, M.A.
• Sonja Miriello, M.S. CCC-SLP
• Mirror Pond Dental, LLC
• Danish Mirza, D.O.
• Kasim Lennox Mirza
• Kelli Mischke, RBT
• Jennifer Michelle Misiak

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2019; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.