NPIMap

Organization Active NPI

The Carol Milgard Breast Center

  • Mammography Clinic/Center
  • Tacoma, WA
National Provider Identifier
1063661098
Registry record updated Sep 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mammography Clinic/CenterTaxonomy code 261QR0206X
Legal business name
THE CAROL MILGARD BREAST CENTER
Practice address
4525 South 19TH Street
Tacoma, WA 98405-1106
Phone
(253) 761-4200
Fax
(253) 761-4201
NPI assigned
Sep 15, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 1, 2023

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

Authorized official

Name
Kirsten Maxwell
Title
Revenue Cycle Manager
Phone
(253) 680-3564

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mammography Clinic/Center 261QR0206X Primary

Addresses

Primary practice location

4525 South 19TH Street
Tacoma, WA 98405-1106

Mailing address

PO Box 1535
Tacoma, WA 98401-1535
Phone (253) 761-4200

Other names 1

  • Carol Milgard Breast Center Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA, WI, NY3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20090203000463 WA Part B Supplier - Clinic/Group Practice 8022172212 Receives reassigned benefits from 16 practitioners
Practice locations: Fox Island, WA; Gig Harbor, WA; Tacoma, WA
O20251021003852 WI Part B Supplier - Clinic/Group Practice 8022172212 Receives reassigned benefits from 1 practitioner
Practice locations: Milwaukee, WI
O20260120000799 NY Part B Supplier - Clinic/Group Practice 8022172212 Receives reassigned benefits from 1 practitioner
Practice locations: Melville, NY

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
50D1095950Carol Milgard Breast Center4525 S 19TH St, Tacoma, WA 98405Certificate of waiverApr 4, 2028

National Provider Directory

National Provider Directory

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

Locations

4700 Point Fosdick Dr
Ste 110
Gig Harbor, WA 98335
Phone (253) 759-2622

Practitioners & affiliated clinicians

Practitioners 24

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

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1221436800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693526400000",
    "number": "1063661098",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1535",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984011535",
            "telephone_number": "253-761-4200",
            "fax_number": "253-761-4201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4525 SOUTH 19TH STREET",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984051106",
            "telephone_number": "253-761-4200",
            "fax_number": "253-761-4201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE CAROL MILGARD BREAST CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-09-15",
        "last_updated": "2023-09-01",
        "certification_date": "2023-09-01",
        "status": "A",
        "authorized_official_last_name": "MAXWELL",
        "authorized_official_first_name": "KIRSTEN",
        "authorized_official_title_or_position": "REVENUE CYCLE MANAGER",
        "authorized_official_telephone_number": "253-680-3564"
    },
    "taxonomies": [
        {
            "code": "261QR0206X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology, Mammography",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Carol Milgard Breast Center",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Carol Milgard Breast Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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 Sep 1, 2023; 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.