NPIMap

Organization Active NPI

Western Washington Medical Group, Inc, PS

  • Ambulatory Surgical Clinic/Center
  • Everett, WA
National Provider Identifier
1013138536
Registry record updated Oct 29, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
Legal business name
WESTERN WASHINGTON MEDICAL GROUP, INC, PS
Practice address
3726 Broadway Suite 206
Everett, WA 98201-3787
Phone
(425) 374-5160
Fax
(425) 374-5161
NPI assigned
May 1, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 29, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kathline H. Sullivan
Title
Administrator
Phone
(425) 374-5176

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X Primary

Addresses

Primary practice location

3726 Broadway Suite 206
Everett, WA 98201-3787

Mailing address

3726 Broadway Suite 206
Everett, WA 98201-3787
Phone (425) 374-5160

Other identifiers 1

IdentifierTypeStateIssuer
7139009MedicaidWA

Other names 1

  • DBA: Gateway Surgery Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20031107000469 WA Part B Supplier - Clinic/Group Practice 7517870314 Receives reassigned benefits from 130 practitioners
32 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Everett, WA; Lynnwood, WA; Marysville, WA; Monroe, WA; Oak Harbor, WA; Snohomish, WA; Anacortes, WA; Arlington, WA…
O20040224000589 WA Part B Supplier - Clinic/Group Practice 6901792365 Receives reassigned benefits from 229 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Bellevue, WA; Seattle, WA; Redmond, WA; Issaquah, WA; Edmonds, WA
O20220426001723 WA Part B Supplier - Ambulatory Surgical Center 7517870314 Practice locations: Everett, WA

Other NPIs with the same Medicare PAC ID 6

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 35

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 35

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Western Washington Medical Group Inc PS Dba Gateway Surgery CenterCCN 50C0001272
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
Western Washington Med GRP21 organizations share this tax ID, including this one

Other organizations with this tax ID 20

Organizations that report the same tax identification number in the National Provider Directory.

View all 20

Locations

2950 Northup Way
Ste 100
Bellevue, WA 98004
Phone (425) 827-7878

515 Minor Ave
Ste 901
Seattle, WA 98104
Phone (206) 838-2585

600 Broadway
Ste 280
Seattle, WA 98122
Phone (206) 386-3550

Practitioners & affiliated clinicians

Practitioners 338

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 338

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1177977600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1540771200000",
    "number": "1013138536",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3726 BROADWAY SUITE 206",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982013787",
            "telephone_number": "425-374-5160",
            "fax_number": "425-374-5161"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3726 BROADWAY SUITE 206",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982013787",
            "telephone_number": "425-374-5160",
            "fax_number": "425-374-5161"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WESTERN WASHINGTON MEDICAL GROUP, INC, PS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-01",
        "last_updated": "2018-10-29",
        "status": "A",
        "authorized_official_last_name": "SULLIVAN",
        "authorized_official_first_name": "KATHLINE",
        "authorized_official_middle_name": "H.",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "425-374-5176"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7139009",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DBA: Gateway Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Everett, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.