MR. JEREMIAH C. BRACK (NPI# 1366835068) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1366835068 |
| Entity Type | Individual |
| Full Name | MR. JEREMIAH C. BRACK |
| Credential | PA-C |
| Practice Address |
3801 5th St Se Suite 110 Puyallup WA 98374-2106 |
| Mailing Address |
805 Madison St Suite 901 Seattle WA 98104-1172 |
| Practice Telephone | 2538459585 |
| Practice Fax Number | 2538481126 |
| Mailing Telephone | 2062648100 |
| Enumeration Date | 2015-03-05 |
| Last Update Date | 2015-03-05 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
PA60544689 | WA | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
3801 5TH ST SE SUITE 110 |
| City | PUYALLUP |
| State | WA |
| Zip Code | 98374-2106 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952399123 | Proliance Surgeons, Inc., P.s. | Clinic/Center | 3801 5th St Se, Suite 110, Puyallup, WA 98374-2106 | 2005-10-11 |
| 1497192629 | Jessica Opal Gardner | Physical Therapist | 3801 5th St Se, 220, Puyallup, WA 98374-2106 | 2013-05-29 |
| 1801029665 | Emily Ossian Hall | Physician Assistant | 3801 5th St Se, Suite 110, Puyallup, WA 98374-2106 | 2009-08-27 |
| 1922114701 | Megan Lynn Charboneau | Orthopaedic Surgery | 3801 5th St Se, Suite 110, Puyallup, WA 98374-2106 | 2006-08-22 |
| 1255363685 | Wendall W Adams | Orthopaedic Surgery | 3801 5th St Se, Suite 110, Puyallup, WA 98374-2106 | 2006-07-07 |
| 1295762979 | Steven K Yamamoto | Orthopaedic Surgery | 3801 5th St Se, Suite 110, Puyallup, WA 98374-2106 | 2006-06-27 |
| 1023044880 | Steven Chas Brack | Orthopaedic Surgery | 3801 5th St Se, Suite 110, Puyallup, WA 98374-2106 | 2006-06-24 |
| 1932135795 | Neal H Shonnard | Orthopaedic Surgery | 3801 5th St Se, Suite 110, Puyallup, WA 98374-2106 | 2006-06-24 |
| 1447286521 | Frederic L Johnstone | Orthopaedic Surgery | 3801 5th St Se, Suite 110, Puyallup, WA 98374-2106 | 2006-06-23 |
| 1366487803 | Lynn Page | Physician Assistant | 3801 5th St Se, Suite 110, Puyallup, WA 98374-2106 | 2006-06-18 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073173977 | Courtney Yant | Registered Nurse | 300 3rd St Se, Puyallup, WA 98374 | 2019-06-13 |
| 1013480508 | Tracy Pina | Massage Therapist | 16909 123rd Ave E, Puyallup, WA 98374 | 2019-01-07 |
| 1922524917 | Edith M Wood | Registered Nurse | 13517 152nd St Ct E, Puyallup, WA 98374 | 2017-08-21 |
| 1669875993 | Jillian C S Longway | Registered Nurse | 11102 Sunrise Blvd E Ste 103, Puyallup, WA 98374 | 2014-10-01 |
| 1427302025 | Nadeem Jaffer | Internal Medicine | 3800 3rd St. Se, Puyallup, WA 98374 | 2012-11-04 |
| 1851605356 | Madigan Army Medical Ctr | Clinic/Center | 15600 Meridan Ave, Sunrise Village Center, East Puyallup, WA 98374 | 2010-07-27 |
| 1326368135 | Matt Karl Jahns | Massage Therapist | 2402 20th St Se, Puyallup, WA 98374 | 2010-06-03 |
| 1982833208 | Roxy Sturgeon | Speech-Language Pathologist | 2309 43rd Ave Se, Puyallup, WA 98374 | 2009-07-08 |
| 1497921191 | Morgan Counseling Services Inc. | Substance Abuse Rehabilitation Facility | 10312 120th Street East, Suite #3, Puyallup, WA 98374 | 2008-05-02 |
| 1700055795 | Walter Royal Patterson Jr. | Registered Nurse | 11102 Sunrise Blvd. E., Ste. 103, Woodcreek Healthcare, Puyallup, WA 98374 | 2008-02-25 |
| Find all providers in zip 98374 | ||||
| Taxonomy Code | 363AS0400X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Surgical Technologist |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700402088 | Ryan Wayne Bahr | Physician Assistant | 3801 5th St Se Ste 110, Puyallup, WA 98374-2106 | 2020-06-22 |
| 1104251792 | Teresa Kathleen Schreiber | Physician Assistant | 1450 5th St Se Ste 4200, Puyallup, WA 98372-4604 | 2013-09-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780153536 | Patricia Dorian | Physician Assistant | 2950 Squalicum Pkwy Ste B, Bellingham, WA 98225-1857 | 2018-11-21 |
| 1851875561 | Sarah Gene Soloff | Physician Assistant | 9730 3rd Ave Ne Ste 201, Seattle, WA 98115-2023 | 2018-09-18 |
| 1104308394 | Johnny Thanh Nguyen | Physician Assistant | 1135 116th Ave Ne Ste 605, Bellevue, WA 98004-4697 | 2018-09-04 |
| 1558843201 | Stefanie Eller | Physician Assistant | 532 Cedar Wood Ln, Wenatchee, WA 98801-2476 | 2018-08-29 |
| 1861987992 | Lillian Baldwin Bourret | Physician Assistant | 6317 Linden Ave N, Seattle, WA 98103-5658 | 2018-07-01 |
| 1417446758 | Janelle Elizabeth Becker | Physician Assistant | 11511 Canterwood Blvd Nw Ste 205, Gig Harbor, WA 98332 | 2018-05-02 |
| 1982058418 | Ray Johnson | Physician Assistant | 4446 88th Ave Se, Mercer Island, WA 98040 | 2016-04-21 |
| 1073990651 | Laura Skanse | Physician Assistant | 12303 Ne 130th Ln #500, Kirkland, WA 98034 | 2015-05-02 |
| 1104231893 | Amber Elaine Deck | Physician Assistant | 20307 67th Ave E, Spanaway, WA 98387-5600 | 2014-06-22 |
| 1043535024 | Pamela Baird | Physician Assistant | 2016 16th Ave East, Seattle, WA 98112-5260 | 2010-04-01 |
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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.