Bellingham Urology Group, PLLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

603455361 Issued in WA

Legal business name

BELLINGHAM UROLOGY GROUP, PLLC

Practice address

340 Birchwood Ave
Bellingham, WA 98225-1782

Phone

(360) 714-3400

Fax

(360) 714-3402

NPI assigned

Jun 4, 2015

Organization subpart

No

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

Authorized official

Name

John M Pettit, MD

Title

Owner

Phone

(360) 714-3400

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

Listed as

Bellingham Urology Group PLLCCCN 50C0001312

Medicare certification status

Terminated Voluntary: merger or closure, Jul 31, 2025From the Provider of Services file

Practitioners 1

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

• Mansel K Kevwitch, M.D.

  • Specialist
  • Anacortes, WA
  • NPI 1568540771
  Medicare reassignment

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

{
    "created_epoch": "1433376000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1442275200000",
    "number": "1043690126",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "340 BIRCHWOOD AVE",
            "city": "BELLINGHAM",
            "state": "WA",
            "postal_code": "982251782",
            "telephone_number": "360-714-3400",
            "fax_number": "360-714-3402"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "340 BIRCHWOOD AVE",
            "city": "BELLINGHAM",
            "state": "WA",
            "postal_code": "982251782",
            "telephone_number": "360-714-3400",
            "fax_number": "360-714-3402"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BELLINGHAM UROLOGY GROUP, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-04",
        "last_updated": "2015-09-15",
        "status": "A",
        "authorized_official_last_name": "PETTIT",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "360-714-3400",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "WA",
            "license": "603455361",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bellingham Spine Pain Specialists, P.S.
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• Bellingham Technical College
• Bellingham Technical College
• Bellingham Urology Group PLLC
• Bellingham Urology Specialists PLLC
• Bellingham Urology Specialists PLLC
• Bellingham Vision Clinic Inc
• Bellingham Wellness Center
• Bellingham Women'S Health, PLLC

• Ambulatory Surgical Clinic/Center in Bellingham, WA
• Providers in Bellingham, WA by specialty
• Ambulatory Surgical Clinic/Center in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2015; 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.