Individual provider Active NPI

Shae Kanakaole, PA-C

  • Surgical Physician Assistant
  • Lakewood, WA
National Provider Identifier
1982110045
Registry record updated May 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
PA61634578 Issued in WA
Practice address
7308 Bridgeport Way W Ste 201
Lakewood, WA 98499-8000
Phone
(253) 582-7257
Fax
(253) 582-1617
NPI assigned
Dec 27, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 29, 2025

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
Surgical Physician Assistant 363AS0400X PA61634578 WA Primary

Addresses

Primary practice location

7308 Bridgeport Way W Ste 201
Lakewood, WA 98499-8000

Mailing address

7308 Bridgeport Way W Ste 201
Lakewood, WA 98499-8000
Phone (253) 582-7257

Other practice location 1

2727 Hollycroft St Ste 410
Gig Harbor, WA 98335-1369
Phone (253) 358-4002

Other practice location 2

1724 W Union Ave Ste 100
Tacoma, WA 98405-2099
Phone (253) 830-5200

Other identifiers 1

IdentifierTypeStateIssuer
2326471MedicaidWA

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
I20250610001173 WA Practitioner - Physician Assistant 8820508765 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Proliance Surgeons Inc P SGroup PAC ID 8527972900, 395 clinicians

Practice addresses (Care Compare)

1401 S Laventure Rd
Mount Vernon, WA 98274-6033
Phone (360) 424-2400

1724 W Union Ave
Tacoma, WA 98405-2099
Phone (253) 830-5200

2727 Hollycroft St
Suite 410
Gig Harbor, WA 98335-1369
Phone (253) 582-7257

7308 Bridgeport Way W
Suite 201
Lakewood, WA 98499-8000
Phone (253) 582-7257

Hospital & facility affiliations

  • St Clare Hospital Hospital, Lakewood, WA, CCN 500021
  • St Joseph Medical Center Hospital, Tacoma, WA, CCN 500108
  • St Anthony Hospital Hospital, Gig Harbor, WA, CCN 500151

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA61634578WAMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Proliance Surgeons Inc P S Surgical CurrentSince May 15, 2025 Accepting new patients
Proliance Surgeons, Inc., P.S. Surgical CurrentSince May 15, 2025 Accepting new patients

Locations

2727 Hollycroft St
Ste 410
Gig Harbor, WA 98335
Phone (253) 358-4002

7308 Bridgeport Way W
Ste 201
Lakewood, WA 98499
Phone (253) 582-7257

1401 S Laventure Rd
Mount Vernon, WA 98274
Phone (360) 424-2400

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

1724 West Union Ave
Ste 100
Tacoma, WA 98405
Phone (253) 830-5200

Interoperability endpoints

  • Direct secure messaging: shae.kanakaole.p73@direct.proliance.nextgenshare.com
  • Direct secure messaging: skanakaole826731@fhsce.catholichealth.net

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 6

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": "1514332800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1748476800000",
    "number": "1982110045",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7308 BRIDGEPORT WAY W STE 201",
            "city": "LAKEWOOD",
            "state": "WA",
            "postal_code": "984998000",
            "telephone_number": "253-582-7257",
            "fax_number": "253-582-1617"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7308 BRIDGEPORT WAY W STE 201",
            "city": "LAKEWOOD",
            "state": "WA",
            "postal_code": "984998000",
            "telephone_number": "253-582-7257",
            "fax_number": "253-582-1617"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2727 Hollycroft St Ste 410",
            "address_purpose": "LOCATION",
            "city": "Gig Harbor",
            "state": "WA",
            "postal_code": "983351369",
            "country_code": "US",
            "telephone_number": "253-358-4002",
            "fax_number": "253-358-4015",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1724 W Union Ave Ste 100",
            "address_purpose": "LOCATION",
            "city": "Tacoma",
            "state": "WA",
            "postal_code": "984052099",
            "country_code": "US",
            "telephone_number": "253-830-5200",
            "fax_number": "253-752-1160",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KANAKAOLE",
        "first_name": "SHAE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-12-27",
        "last_updated": "2025-05-29",
        "certification_date": "2025-05-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "WA",
            "license": "PA61634578",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2326471",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lakewood, WA

Sources for this page

Verify at the official NPI Registry.