SAMRA EJAZ KHAN
NPI 1639650781
Physician Assistant in Kent, WA

Active since August 27, 2018PECOS EnrolledAccepts Medicare Assignment
26004 104TH AVE SE, KENT, WA 98030(425) 251-4040(425) 251-4126 Get Directions Write a Review

NPPES record last updated: April 22, 2021. Verified against the NPPES registry weekly; last sync: July 19, 2026.

Record update history: Apr 22, 2021, Feb 6, 2020, Jan 12, 2020 and 1 more (4 updates tracked since 2018).

About Samra Ejaz Khan NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SAMRA EJAZ KHAN (NPI 1639650781) is an individual physician assistant in Kent, Washington, licensed in Washington (PA61007133) and active in the NPI registry since August 2018. She is enrolled in Medicare PECOS and is a graduate of Other (2019).

NPPES Registry Identity

NPI1639650781
Entity TypeIndividualFemale
Primary Taxonomy363A00000X
Provider Legal NameSAMRA EJAZ KHAN
Location Address26004 104TH AVE SEKent, WA 98030-7677
Mailing Address26004 104th Ave SeKent, WA 98030-7677 · (425) 251-4040 · Fax (425) 251-4126
Fax(425) 251-4126
Sole ProprietorNo
Medical School CMSOtherGraduated 2019
Enumeration DateAugust 27, 2018
Last NPPES UpdateApril 22, 20214 updates tracked since enumeration
NPPES CertifiedApril 22, 2021
NPI 1639650781 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363A00000X
License Licensed in WA · PA61007133
Definition

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.

26004 104TH AVE SE, Kent, WA 98030

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

Enrolled in Medicare and accepts Medicare assignment

Samra Ejaz Khan is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID244667467
PECOS Enrollment IDI20200228001458
Eligible to Order & Refer Part B Labs & Imaging Durable Medical Equipment Home Health Agency Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 98030 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$97.43 typical visit price
range $63.67 – $189.37
Typical copayment $24.35 (range $15.91 – $47.34)
Most-billed visit code 99203
Established Patient
$78.74 typical visit price
range $21.12 – $155.00
Typical copayment $19.68 (range $5.28 – $38.75)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 18

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Pharmacist
26004 104TH AVE SE
KENT, WA 98030
Physician Assistant
26004 104TH AVE SE
KENT, WA 98030
Pharmacist
26004 104TH AVE SE
KENT, WA 98030
Pharmacist
26004 104TH AVE SE
KENT, WA 98030
Pharmacist
26004 104TH AVE SE
KENT, WA 98030
Pharmacist
26004 104TH AVE SE
KENT, WA 98030
Pharmacist
26004 104TH AVE SE
KENT, WA 98030
Family Medicine
26004 104TH AVE SE
KENT, WA 98030

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1639650781, enumerated as an "individual" on August 27, 2018.

The provider is located at 26004 104TH AVE SE KENT, WA 98030 and the phone number is (425) 251-4040.

Physician Assistant with taxonomy code 363A00000X.