Active NPI
Bradley Coon, PA-C
- Surgical Physician Assistant
- Seattle, WA
National Provider Identifier
1952592883
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Physician Assistant
- License
- PA10005021
- Practice address
- 1145 Broadway
Seattle, WA 98122-4201 - Phone
- (206) 329-1760
- NPI assigned
- Aug 6, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgical Physician Assistant | 363AS0400X | PA10005021 | WA | Primary |
Addresses
Primary practice location
1145 Broadway
Seattle, WA 98122-4201
Mailing address
1145 Broadway
Seattle, WA 98122-4201
Phone (206) 329-1760
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8490161 | Medicaid | WA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| The Polyclinic PLLC | Current | Accepting new patients | |
| The Polyclinic PLLC | Current | Accepting new patients |
Locations
1145 Broadway
Seattle, WA 98122
1101 Madison St
Ste 200
Seattle, WA 98104
Phone (206) 320-7750
Organizations & group practices 2
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.
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- Durable Medical Equipment & Medical Supplies
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- NPI 1831411487
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1186358400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1206057600000",
"number": "1952592883",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1145 BROADWAY",
"city": "SEATTLE",
"state": "WA",
"postal_code": "981224201",
"telephone_number": "206-329-1760"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1145 BROADWAY",
"city": "SEATTLE",
"state": "WA",
"postal_code": "981224201",
"telephone_number": "206-329-1760"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COON",
"first_name": "BRADLEY",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-08-06",
"last_updated": "2008-03-21",
"status": "A"
},
"taxonomies": [
{
"code": "363AS0400X",
"taxonomy_group": "",
"desc": "Physician Assistant, Surgical",
"state": "WA",
"license": "PA10005021",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8490161",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Seattle, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2008; 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.