NPIMap

Organization Active NPI

Pacific Vascular Incorporated

  • Physiological Laboratory
  • Auburn, WA
National Provider Identifier
1043365257
Registry record updated Dec 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physiological LaboratoryTaxonomy code 293D00000X
Legal business name
PACIFIC VASCULAR INCORPORATED
Practice address
1 E Main St
Suite 120
Auburn, WA 98002-4905
Phone
(253) 887-8673
Fax
(425) 486-8976
NPI assigned
Jan 25, 2007
Last updated
Dec 2, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
PACIFIC VASCULAR INCORPORATEDAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 2, 2025

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

Authorized official

Name
Bonnie M Brown, RVT
Title
Ceo/Technical Director
Phone
(425) 398-7781

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physiological Laboratory 293D00000X Primary

Addresses

Primary practice location

1 E Main St
Suite 120
Auburn, WA 98002-4905

Mailing address

11714 N Creek Pkwy N Ste 100
Bothell, WA 98011-8250
Phone (425) 486-8868

Other identifiers 2

IdentifierTypeStateIssuer
7015852MedicaidWA
P00217284OtherWARAILROAD MEDICARE

Other names 1

  • Pacific Vascular- Auburn Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040609001412 WA Part B Supplier - Independent Diagnostic Testing Facility (Idtf) 9739073388 Practice locations: Auburn, WA

Other NPIs with the same Medicare PAC ID 13

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

View all 13

National Provider Directory

National Provider Directory
Tax ID family
Pacific Vascular15 organizations share this tax ID, including this one
Part of
Pacific Vascular

Other organizations with this tax ID 14

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

View all 14

Locations

3999 Englewood Ave
Ste 203
Yakima, WA 98902
Phone (509) 452-2688

Practitioners & affiliated clinicians

Practitioners 17

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.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1169683200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1764633600000",
    "number": "1043365257",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11714 N CREEK PKWY N STE 100",
            "city": "BOTHELL",
            "state": "WA",
            "postal_code": "980118250",
            "telephone_number": "425-486-8868",
            "fax_number": "425-486-8976"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 E MAIN ST",
            "address_2": "SUITE 120",
            "city": "AUBURN",
            "state": "WA",
            "postal_code": "980024905",
            "telephone_number": "253-887-8673",
            "fax_number": "425-486-8976"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFIC VASCULAR INCORPORATED",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PACIFIC VASCULAR INCORPORATED",
        "enumeration_date": "2007-01-25",
        "last_updated": "2025-12-02",
        "certification_date": "2025-12-02",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "BONNIE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CEO/TECHNICAL DIRECTOR",
        "authorized_official_telephone_number": "425-398-7781",
        "authorized_official_credential": "RVT"
    },
    "taxonomies": [
        {
            "code": "293D00000X",
            "taxonomy_group": "",
            "desc": "Physiological Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7015852",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00217284",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pacific Vascular- Auburn",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Pacific Vascular- Auburn",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Auburn, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2025; 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.