JASON MAYBERRY (NPI# 1255403861) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1255403861 |
| Entity Type | Individual |
| Full Name | JASON MAYBERRY |
| Credential | PAC |
| Practice Address |
62 W 7th Ave Ste 110 Spokane WA 99204-2321 |
| Practice Telephone | 5094626485 |
| Practice Fax Number | 5094625059 |
| Mailing Telephone | 5094626485 |
| Mailing Fax Number | 5094625059 |
| Enumeration Date | 2006-11-15 |
| Last Update Date | 2019-09-04 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363A00000X | Physician Assistant | PA19289 | CA | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
PA60698165 | WA | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MEDICARE INDIVIDUAL PTAN | 0PA192890 | 01 | |
| CA | LICENSE | PA19289 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235462722 | Jason Mayberry | Mechanotherapist | 4445 Sw Barbur Blvd, Suite 104, Portland, OR 97239-4047 | 2009-09-15 |
| Street Address |
62 W 7TH AVE STE 110 |
| City | SPOKANE |
| State | WA |
| Zip Code | 99204-2321 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801894811 | Leland G. Siwek | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 62 W 7th Ave Ste 110, Spokane, WA 99204-2321 | 2005-07-13 |
| 1053873158 | Davin Valenti | Nurse Practitioner | 62 W 7th Ave Ste 110, Spokane, WA 99204-2321 | 2019-04-05 |
| 1275998114 | Annamarie Rose Vaughan | Physician Assistant | 62 W 7th Ave Ste 110, Spokane, WA 99204 | 2015-12-18 |
| 1730569492 | Bart D Brinkmann | Nurse Practitioner | 62 W 7th Ave Ste 110, Spokane, WA 99204-2321 | 2015-06-08 |
| 1730584483 | Laurel Cope | Physician Assistant | 62 W 7th Ave Ste 110, Spokane, WA 99204 | 2014-10-23 |
| 1295137578 | Sara C Zimmer | Physician Assistant | 62 W 7th Ave Ste 110, Spokane, WA 99204-2321 | 2014-09-18 |
| 1376878447 | James L Garcia | Physician Assistant | 62 W 7th Ave Ste 110, Spokane, WA 99204-2321 | 2009-10-07 |
| 1750523577 | Alexi Matousek | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 62 W 7th Ave Ste 110, Spokane, WA 99204-2321 | 2009-03-25 |
| 1538311287 | Providence Health & Services-wa | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 62 W 7th Ave Ste 110, Spokane, WA 99204-2321 | 2008-10-14 |
| 1386805539 | Matthew Donavon Forrester | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 62 W 7th Ave Ste 110, Spokane, WA 99204-2321 | 2008-06-20 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982250957 | Megan Elizabeth Dibenedetto | Pharmacist | 105 West 8th Avenue, 350e, Spokane, WA 99204 | 2019-08-14 |
| 1619521168 | Evelyn R Cabon | Genetic Counselor, MS | 101 W. 8th Avenue Suite 1100, Spokane, WA 99204 | 2019-08-01 |
| 1346700655 | Christina Rose | Student in an Organized Health Care Education/Training Program | 120 W. 8th Avenue, Spokane, WA 99204 | 2019-03-22 |
| 1508339862 | Cody J French | Physical Therapist | Washington Outpatient Rehab, 507 S Washington, Spokane, WA 99204 | 2019-01-09 |
| 1730655598 | Washington Outpatient Rehabilitation, LLC | Physical Therapist | 507 S. Washington St., Suite 10, Spokane, WA 99204 | 2018-10-19 |
| 1013405547 | Joel James Hayden | Student in an Organized Health Care Education/Training Program | Providence Sacred Heart, 101 West 8th Avenue, Spokane, WA 99204 | 2018-04-30 |
| 1144694787 | Brooksjohnsonpllc | Dentist | 1004 S. Monroe Street, Ste 100, Spokane, WA 99204 | 2015-11-19 |
| 1497184196 | Kathalene M Cassels | Physician Assistant | 810 W. 5th Ave. Ste 510, Spokane, WA 99204 | 2013-11-04 |
| 1174880454 | Kelly E Wurzel | Psychiatry & Neurology | 624 E. Front Ave, Spokane, WA 99204 | 2012-04-11 |
| 1003190331 | Katie L Gomez | Nurse Practitioner | 805 W. 5th Ave, Suite 518, Spokane, WA 99204 | 2011-10-05 |
| Find all providers in zip 99204 | ||||
| Taxonomy Code | 363AS0400X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Surgical Technologist |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528201415 | Molly Rose Morgan | Physician Assistant | 105 W 8th Ave Ste 532, Spokane, WA 99204-2318 | 2009-04-08 |
| 1033264056 | Kristin Michele Treece | Physician Assistant | 212 E Central Ave Ste 245, Spokane, WA 99208 | 2007-01-23 |
| 1588663835 | Ted A. Branstetter | Physician Assistant | 910 W 5th Ave, Ste 1000, Spokane, WA 99204-2966 | 2005-07-19 |
| 1598112211 | Kellen Gumm | Physician Assistant | 122 W 7th Ave Ste 110, Spokane, WA 99204-2301 | 2016-05-23 |
| 1275998114 | Annamarie Rose Vaughan | Physician Assistant | 62 W 7th Ave Ste 110, Spokane, WA 99204 | 2015-12-18 |
| 1720471774 | Miranda K Detore | Physician Assistant | 217 W Cataldo Ave, Spokane, WA 99201-2217 | 2015-03-16 |
| 1295137578 | Sara C Zimmer | Physician Assistant | 62 W 7th Ave Ste 110, Spokane, WA 99204-2321 | 2014-09-18 |
| 1811321607 | Matthew Garrett Sutter | Physician Assistant | 212 E Central Ave Ste 245, Spokane, WA 99208-6289 | 2013-08-28 |
| 1396026555 | Justin Wade Sassone | Physician Assistant | 910 W 5th Ave, Suite 900, Spokane, WA 99204-2966 | 2011-09-01 |
| 1578712923 | Danny Lee Jones II | Physician Assistant | 820 S Mcclellan St, Suite 300, Spokane, WA 99204-2457 | 2008-09-10 |
| Find all providers in SPOKANE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.