NPIMap

Organization Active NPI

Eastside Internal Medicine PLLC

  • Medical Specialty Clinic/Center
  • Kirkland, WA
National Provider Identifier
1023165594
Registry record updated Dec 18, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Specialty Clinic/CenterTaxonomy code 261QM2500X
Legal business name
EASTSIDE INTERNAL MEDICINE PLLC
Practice address
12333 NE 120TH LN. Ste 310
Kirkland, WA 98034
Phone
(425) 899-6700
Fax
(425) 899-6701
NPI assigned
Jan 5, 2007
Last updated
Dec 18, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 18, 2007

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

Authorized official

Name
Dr. Douglas A PortelanceNPI 1932291127
Title
MD President
Phone
(425) 899-6700

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Specialty Clinic/Center 261QM2500X WA Primary

Addresses

Primary practice location

12333 NE 120TH LN. Ste 310
Kirkland, WA 98034

Mailing address

12333 NE 120TH LN. Ste 310
Kirkland, WA 98034

Other identifiers 1

IdentifierTypeStateIssuer
145684OtherWALABOR & INDUSTRIES

National Provider Directory

National Provider Directory

Locations

12333 NE 130th Ln
Ste 310
Kirkland, WA 98034
Phone (425) 899-6700

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1167955200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1197936000000",
    "number": "1023165594",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12333 NE 120TH LN. STE 310",
            "city": "KIRKLAND",
            "state": "WA",
            "postal_code": "98034"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12333 NE 120TH LN. STE 310",
            "city": "KIRKLAND",
            "state": "WA",
            "postal_code": "98034",
            "telephone_number": "425-899-6700",
            "fax_number": "425-899-6701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTSIDE INTERNAL MEDICINE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-05",
        "last_updated": "2007-12-18",
        "status": "A",
        "authorized_official_last_name": "PORTELANCE",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "MD PRESIDENT",
        "authorized_official_telephone_number": "425-899-6700",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "WA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LABOR & INDUSTRIES",
            "identifier": "145684",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kirkland, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.