Active NPI
Franciscan Medical Group
- Surgery Physician
- Lakewood, WA
National Provider Identifier
1053559682
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- Legal business name
- FRANCISCAN MEDICAL GROUP
- Practice address
- 11307 Bridgeport Way SW
Ste 220
Lakewood, WA 98499-3024 - Phone
- (253) 985-6141
- Fax
- (253) 985-2868
- NPI assigned
- Feb 4, 2009
- Organization subpart
- Yes
- Parent organization
- FRANCISCAN MEDICAL GROUP
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Cliff Robertson, MD
- Title
- President
- Phone
- (253) 680-4014
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | Primary |
Addresses
Primary practice location
11307 Bridgeport Way SW
Ste 220
Lakewood, WA 98499-3024
Mailing address
11307 Bridgeport Way SW
Ste 220
Lakewood, WA 98499-3024
Phone (253) 985-6141
Other names 1
- FMG-Franciscan Acute Surgical Team
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031111000789 | WA | Part B Supplier - Clinic/Group Practice | 0547173866 |
Receives reassigned benefits from 1,720 practitioners This NPI is an additional NPI on the enrollment |
National Provider Directory
National Provider Directory- Part of
- Enumclaw Medical Center
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1233705600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1233705600000",
"number": "1053559682",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11307 BRIDGEPORT WAY SW",
"address_2": "STE 220",
"city": "LAKEWOOD",
"state": "WA",
"postal_code": "984993024",
"telephone_number": "253-985-6141",
"fax_number": "253-985-2868"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11307 BRIDGEPORT WAY SW",
"address_2": "STE 220",
"city": "LAKEWOOD",
"state": "WA",
"postal_code": "984993024",
"telephone_number": "253-985-6141",
"fax_number": "253-985-2868"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "FRANCISCAN MEDICAL GROUP",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "FRANCISCAN MEDICAL GROUP",
"enumeration_date": "2009-02-04",
"last_updated": "2009-02-04",
"status": "A",
"authorized_official_last_name": "ROBERTSON",
"authorized_official_first_name": "CLIFF",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "253-680-4014",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Surgery",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "FMG-Franciscan Acute Surgical Team",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Lakewood, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2009; 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.