NPIMap

Organization Active NPI

Manette Clinic a Professional Service Corporation

  • Clinic/Center
  • Bremerton, WA
National Provider Identifier
1013383215
Registry record updated Jun 16, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
AP30007455 Issued in WA
Legal business name
MANETTE CLINIC A PROFESSIONAL SERVICE CORPORATION
Practice address
1100 Wheaton Way
Suite F and G
Bremerton, WA 98310-4459
Phone
(360) 621-2696
Fax
(844) 602-4646
NPI assigned
Aug 11, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2021

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

Authorized official

Name
Mrs. Tanya Spoon, DNP, ARNPNPI 1356427918
Title
Owner
Phone
(360) 621-2696

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X AP30007455 WA Primary

Addresses

Primary practice location

1100 Wheaton Way
Suite F and G
Bremerton, WA 98310-4459

Mailing address

PO Box 1266
Bremerton, WA 98337-0507
Phone (360) 621-2696

Other practice location 1

19500 10th Ave NE Ste 100
Poulsbo, WA 98370-6331
Phone (360) 621-2696

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20151217000562 WA Part B Supplier - Clinic/Group Practice 3779884713 Receives reassigned benefits from 6 practitioners
Practice locations: Bremerton, WA; Poulsbo, WA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
50D2101202The Manette Clinic1100 Wheaton Way Ste F and G, Bremerton, WA 98310Certificate of waiverApr 4, 2028

National Provider Directory

National Provider Directory

Locations

1100 Wheaton Way
Ste F
Bremerton, WA 98310
Phone (360) 621-2696

1100 Wheaton Way
Ste Fg
Bremerton, WA 98310
Phone (360) 621-2696

1100 Wheaton Way
Ste Fandg
Bremerton, WA 98310

Practitioners & affiliated clinicians

Practitioners 6

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

NPI Registry JSON

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

{
    "created_epoch": "1439251200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1623801600000",
    "number": "1013383215",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1266",
            "city": "BREMERTON",
            "state": "WA",
            "postal_code": "983370507",
            "telephone_number": "360-621-2696"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 WHEATON WAY",
            "address_2": "SUITE F AND G",
            "city": "BREMERTON",
            "state": "WA",
            "postal_code": "983104459",
            "telephone_number": "360-621-2696",
            "fax_number": "844-602-4646"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "19500 10th Ave NE Ste 100",
            "address_purpose": "LOCATION",
            "city": "Poulsbo",
            "state": "WA",
            "postal_code": "983706331",
            "country_code": "US",
            "telephone_number": "360-621-2696",
            "fax_number": "844-602-4646",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MANETTE CLINIC A PROFESSIONAL SERVICE CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-08-11",
        "last_updated": "2021-06-16",
        "certification_date": "2021-06-16",
        "status": "A",
        "authorized_official_last_name": "SPOON",
        "authorized_official_first_name": "TANYA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "360-621-2696",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "DNP, ARNP"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "WA",
            "license": "AP30007455",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bremerton, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2021; 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.