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Justin Mandeville , PA-C

Physician Assistant β€’ Yelm, WA

Active NPI 1073019550 Individual Practitioner Male Practitioner
Practice location in NPPES

9391 Prarrie Wind St
Yelm, WA 98597

Call 5176678729 Location details and other listings
Medical Disclaimer

This profile restates public CMS/NPPES data; T-MedInfo gives no medical advice — consult a licensed professional, and call 911 for emergencies.

Practice Location & Contact Primary Location

Practice Address

9391 Prarrie Wind St

Yelm, WA 98597

Telephone 5176678729

Industry payments (Open Payments)

No Open Payments records are listed for this clinician for 2021–2025.

Guide: How to read an Open Payments record

NPI first issued

2018

The year this clinician's National Provider Identifier (NPI) was issued. An NPI is a unique 10-digit ID that US health care providers use for billing.

What this does not show: NPI first issued

NPIs have been issued only since 2005, so this year is not necessarily when the clinician started practicing.

Source: CMS NPPES NPI Registry.

Medicare assignment not listed

CMS data do not show whether this clinician accepts Medicare assignment. This does not mean they do not accept Medicare. Ask the office.

Medicare assignment applies to Original Medicare. It does not tell you whether the clinician is in a Medicare Advantage plan's network, accepts other insurance, or is taking new patients.

Source: CMS Doctors and Clinicians; Medicare.gov, β€œDoes your provider accept Medicare as full payment?”

Guide: What Medicare assignment means

No telehealth indicator

CMS shows this indicator only when recent Medicare claims include telehealth services. The clinician may still offer telehealth; ask the office.

Source: CMS, Telehealth Indicator on Medicare Care Compare (fact sheet, January 2023); CMS Doctors and Clinicians.

Guide: How Medicare covers telehealth

Compared with the same specialty in Yelm and Washington

1 active clinicians are listed under Physician Assistant with a practice address in Yelm, WA (3,803 in Washington).

Addresses are self-reported to NPPES and may be out of date.

Sources: CMS Doctors and Clinicians, CMS NPPES NPI Registry. Specialty names follow the NUCC Health Care Provider Taxonomy.

Text: T-MedInfo Β· Report an error.

Specialties & License Numbers Reported to NPPES

Self-certified to NPPES: 2023-07-24
Physician Assistant Primary Specialty

NUCC Taxonomy Code: 363A00000X

A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.

Check License Status with the State Board License numbers are self-reported to NPPES; T-MedInfo does not confirm them against state records. Current status: Washington State Department of Health Provider Lookup.
Look Up on State Board Site

Career & Practice History Timeline

Changes recorded in monthly NPPES data files: addresses, names, credentials, specialties and NPI status

9 Historical Events
πŸ“
Updated Practice Location July 25, 2023

Registered at 9391 PRARRIE WIND ST, YELM, WA 98597 (Tel: 5176678729)

πŸ“
Updated Business Mailing Address July 25, 2023

Registered at BLDG 11582 C STREET, OKUBO CLINIC, JBLM, WA 98433

πŸ‘€
Provider Name / Credentials Updated July 25, 2023

Recorded as JUSTIN MANDEVILLE, PA-C

βœ…
NPI Profile Active April 05, 2018

NPI status registered as active in NPPES database

πŸ“
Practice Location (Initial Record) April 05, 2018

Registered at 210 E NEEDMORE HWY, GRAND LEDGE, MI 488379438 (Tel: 5176678729)

πŸ“
Business Mailing Address (Initial Record) April 05, 2018

Registered at LANDSTUHL REGIONAL MEDCEN, ATTN: MCEU-LST-QM-CR UNIT 33100, APO, AE 09180

πŸ‘€
Provider Name / Credentials (Initial Record) April 05, 2018

Recorded as JUSTIN MANDEVILLE

πŸŽ“
Medical Taxonomy / Specialty Registered (Primary Specialty) April 05, 2018

Physician Assistant

🟒
Initial NPI Registration & Enumeration April 03, 2018

First registered as active Individual Practitioner in NPPES Database.

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NPI Administrative Meta

NPI Number: 1073019550
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: April 03, 2018
Last Update: July 25, 2023
Sole Proprietor: No

Mailing Address

Bldg 11582 C Street, Okubo Clinic

Jblm, WA 98433

About This Data NPPES fields (address, phone, specialty, license) are self-reported and may be outdated; Medicare fields follow the CMS dataset named in each section. Correct directly at NPPES.