Basic Information
Provider Information | |||||||||
NPI: | 1700855574 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | ROMRIELL | ||||||||
FirstName: | JASON | ||||||||
MiddleName: | A | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | PA-C | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 601 W 5TH AVE STE 400 | ||||||||
Address2: |   | ||||||||
City: | SPOKANE | ||||||||
State: | WA | ||||||||
PostalCode: | 992042715 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5093442663 | ||||||||
FaxNumber: | 5096249179 | ||||||||
Practice Location | |||||||||
Address1: | 601 W 5TH AVE STE 400 | ||||||||
Address2: |   | ||||||||
City: | SPOKANE | ||||||||
State: | WA | ||||||||
PostalCode: | 992042715 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5093442663 | ||||||||
FaxNumber: | 5096249179 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/15/2006 | ||||||||
LastUpdateDate: | 12/07/2015 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA-684 | ID | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |   | 363AS0400X | PA-684 | ID | N |   | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical | 363A00000X | PA10004260 | WA | N |   | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |   |
ID Information
ID | Type | State | Issuer | Description | 8893RO | 01 | WA | ASURIS NW HEATLH | OTHER | 0157290 | 01 | WA | DEPT OF LABOR & INDUSTRIE | OTHER | 970024321 | 01 | WA | RR MEDICARE | OTHER | 000010145420 | 01 | ID | REGENCE BLUE SHIELD OF ID | OTHER | 20003823 | 01 | ID | MEDICARE PTAN | OTHER | 379109600 | 01 | WA | OWCP | OTHER | K6484 | 01 | ID | BLUE CROSS OF IDAHO | OTHER | 807036200 | 05 | ID |   | MEDICAID | 8387334 | 05 | WA |   | MEDICAID | 23795 | 01 | WA | GROUP HEALTH NW | OTHER | 8903289 | 01 | WA | CRIME VICTIMS | OTHER |