NPIMap

Organization Active NPI

Proliance Surgeons, Inc., P.S

Doing business as Proliance Surgeons Seattle Neuro and Spine Surgery

  • Orthopaedic Surgery of the Spine Physician
  • Seattle, WA
National Provider Identifier
1063924116
Registry record updated Oct 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery of the Spine PhysicianTaxonomy code 207XS0117X
Legal business name
PROLIANCE SURGEONS, INC., P.S
Doing business as
Proliance Surgeons Seattle Neuro and Spine Surgery
Proliance Surgeons Seattle Spine Surgery
Practice address
801 Broadway Ste 617
Seattle, WA 98122-4319
Phone
(206) 623-0922
Fax
(206) 623-1588
NPI assigned
Oct 30, 2017
Last updated
Oct 18, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 18, 2024

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

Authorized official

Name
Cori M. Pleasant
Title
MGR Provider Relations/Enrollment
Phone
(206) 838-2585

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X NU
Surgical Physician Assistant 363AS0400X NU
Neurological Surgery Physician 207T00000X NU
Orthopaedic Surgery of the Spine Physician 207XS0117X NU Primary

Addresses

Primary practice location

801 Broadway Ste 617
Seattle, WA 98122-4319

Mailing address

801 Broadway Ste 617
Seattle, WA 98122-4319
Phone (206) 623-0922

Other practice location 1

751 NE Blakely Dr Ste 4020
Issaquah, WA 98029-6201
Phone (206) 623-0922

Other practice location 2

20700 Bond Rd NE Ste 105
Poulsbo, WA 98370-9099
Phone (206) 623-0922

Other identifiers 3

IdentifierTypeStateIssuer
2094729MedicaidWA
383896OtherWAWA LABOR & INDUSTRIES
629157500OtherWAOWCP

Other names 2

  • Proliance Surgeons Seattle Neuro and Spine Surgery Doing business as
  • Proliance Surgeons Seattle Spine Surgery Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031119000128 WA Part B Supplier - Clinic/Group Practice 8527972900 Receives reassigned benefits from 781 practitioners
This NPI is an additional NPI on the enrollment

National Provider Directory

National Provider Directory

Locations

20700 Bond Rd NE
Ste 105
Poulsbo, WA 98370
Phone (206) 623-0922

801 Broadway
Ste 617
Seattle, WA 98122
Phone (206) 623-0922

Practitioners & affiliated clinicians

Practitioners 28

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 28

NPI Registry JSON

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

{
    "created_epoch": "1509321600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729209600000",
    "number": "1063924116",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 BROADWAY STE 617",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981224319",
            "telephone_number": "206-623-0922"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 BROADWAY STE 617",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981224319",
            "telephone_number": "206-623-0922",
            "fax_number": "206-623-1588"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "751 NE Blakely Dr Ste 4020",
            "address_purpose": "LOCATION",
            "city": "Issaquah",
            "state": "WA",
            "postal_code": "980296201",
            "country_code": "US",
            "telephone_number": "206-623-0922",
            "fax_number": "206-623-1588",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "20700 Bond Rd NE Ste 105",
            "address_purpose": "LOCATION",
            "city": "Poulsbo",
            "state": "WA",
            "postal_code": "983709099",
            "country_code": "US",
            "telephone_number": "206-623-0922",
            "fax_number": "206-623-1588",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PROLIANCE SURGEONS, INC., P.S",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-10-30",
        "last_updated": "2024-10-18",
        "certification_date": "2024-10-18",
        "status": "A",
        "authorized_official_last_name": "PLEASANT",
        "authorized_official_first_name": "CORI",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "MGR PROVIDER RELATIONS/ENROLLMENT",
        "authorized_official_telephone_number": "206-838-2585"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207XS0117X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Orthopaedic Surgery of the Spine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2094729",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WA LABOR & INDUSTRIES",
            "identifier": "383896",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OWCP",
            "identifier": "629157500",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Proliance Surgeons Seattle Neuro and Spine Surgery",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Proliance Surgeons Seattle Neuro and Spine Surgery",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Proliance Surgeons Seattle Spine Surgery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Seattle, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2024; 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.