NPIMap

Organization Active NPI

Prideaux-Blodgett LLC

Doing business as Pacific Northwest Primary Care

  • Family Nurse Practitioner
  • Tacoma, WA
National Provider Identifier
1023431095
Registry record updated Jan 28, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
AP30003968 Issued in WA
Legal business name
PRIDEAUX-BLODGETT LLC
Doing business as
Pacific Northwest Primary Care
Practice address
1818 S Union Ave
Suite 2a
Tacoma, WA 98405-1953
Phone
(253) 473-7637
Fax
(253) 671-8472
NPI assigned
Jan 28, 2014
Last updated
Jan 28, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 28, 2014

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

Authorized official

Name
Becky Blodgett, ARNP
Title
NP
Phone
(253) 473-7637

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse PractitionerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 363LF0000X AP30003968 WA Primary

Addresses

Primary practice location

1818 S Union Ave
Suite 2a
Tacoma, WA 98405-1953

Mailing address

1818 S Union Ave
Suite 2a
Tacoma, WA 98405-1953
Phone (253) 473-7637

Other names 1

  • Pacific Northwest Primary Care Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140415001060 WA Part B Supplier - Clinic/Group Practice 4284866716 Receives reassigned benefits from 1 practitioner
Practice locations: Tacoma, WA

National Provider Directory

National Provider Directory

Locations

7808 Pacific Ave
Ste 3
Tacoma, WA 98408
Phone (253) 473-7637

Practitioners & affiliated clinicians

Practitioners 3

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": "1390867200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1390867200000",
    "number": "1023431095",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1818 S UNION AVE",
            "address_2": "SUITE 2A",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984051953",
            "telephone_number": "253-473-7637",
            "fax_number": "253-671-8472"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1818 S UNION AVE",
            "address_2": "SUITE 2A",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984051953",
            "telephone_number": "253-473-7637",
            "fax_number": "253-671-8472"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIDEAUX-BLODGETT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-28",
        "last_updated": "2014-01-28",
        "status": "A",
        "authorized_official_last_name": "BLODGETT",
        "authorized_official_first_name": "BECKY",
        "authorized_official_title_or_position": "NP",
        "authorized_official_telephone_number": "253-473-7637",
        "authorized_official_credential": "ARNP"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "WA",
            "license": "AP30003968",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pacific Northwest Primary Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tacoma, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.