NPIMap

Individual provider Active NPI

Jeffrey D Stepanian, PAC

  • Surgical Physician Assistant
  • Kirkland, WA
National Provider Identifier
1932132099
Registry record updated Oct 7, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
PA10004101 Issued in WA
Practice address
12911 120TH Ave NE
Suite H-210
Kirkland, WA 98034-3027
Phone
(425) 823-4000
Fax
(425) 821-3550
NPI assigned
Jul 9, 2006
Last updated
Oct 7, 2011By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 7, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X PA10004101 WA Primary

Addresses

Primary practice location

12911 120TH Ave NE
Suite H-210
Kirkland, WA 98034-3027

Mailing address

805 Madison St
Suite 901
Seattle, WA 98104-1172
Phone (206) 264-8100

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
I20050106000862 WA Practitioner - Physician Assistant 6103874052 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

12033 NE 130TH LN
Suite 120
Kirkland, WA 98034-3052
Phone (425) 899-2160

12039 NE 128TH St
Kirkland, WA 98034-3029

12040 NE 128TH St
Kirkland, WA 98034-3013

12040 NE 128TH St Ms
Suite 55
Kirkland, WA 98034-3013

12333 NE 130TH LN
Kirkland, WA 98034-7467

14841 179TH Ave SE
Monroe, WA 98272-1127

1909 214TH St SE
Suite 110
Bothell, WA 98021-4412
Phone (425) 488-4988

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA10004101WAMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Optum Care Washington PLLC CurrentSince Aug 12, 2019 Accepting new patients
Proliance Surgeons Inc P S Surgical CurrentSince Jan 1, 2001 Accepting new patients
King County Public Hospital District No. 2 CurrentSince Oct 1, 2020 Accepting new patients
Optum Care Washington PLLC CurrentSince Aug 12, 2019 Accepting new patients
Proliance Surgeons, Inc., P.S. CurrentSince Jan 1, 2001 Accepting new patients
King County Public Hospital District No 2 CurrentSince Oct 1, 2020 Accepting new patients

Locations

1909 214th St SE
Ste 110
Bothell, WA 98021
Phone (425) 488-4988

1330 Rockefeller Ave
Everett, WA 98201
Phone (425) 258-3903

510 8th Ave NE
Ste 200
Issaquah, WA 98029
Phone (425) 392-3030

12911 120th Ave NE
Ste H120
Kirkland, WA 98034
Phone (425) 823-4226

12911 120th Ave NE
Ste H210
Kirkland, WA 98034
Phone (425) 823-4000

14841 179th Ave SE
Ste 330
Monroe, WA 98272
Phone (360) 794-3300

805 Madison St
Ste 901
Seattle, WA 98104
Phone (206) 264-8100

1201 N 175th St
Shoreline, WA 98133
Phone (425) 339-4299

Organizations & group practices 9

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 3

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": "1152403200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1317945600000",
    "number": "1932132099",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "805 MADISON ST",
            "address_2": "SUITE 901",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981041172",
            "telephone_number": "206-264-8100",
            "fax_number": "206-264-8689"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12911 120TH AVE NE",
            "address_2": "SUITE H-210",
            "city": "KIRKLAND",
            "state": "WA",
            "postal_code": "980343027",
            "telephone_number": "425-823-4000",
            "fax_number": "425-821-3550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STEPANIAN",
        "first_name": "JEFFREY",
        "middle_name": "D",
        "name_prefix": "Mr.",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-09",
        "last_updated": "2011-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "WA",
            "license": "PA10004101",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kirkland, WA

Sources for this page

Verify at the official NPI Registry.