NPIMap

Organization Active NPI

Puget Sound Kidney Centers

Doing business as PSKC Anacortes

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Anacortes, WA
National Provider Identifier
1073939062
Registry record updated Feb 4, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
License
600401431 Issued in WA
Legal business name
PUGET SOUND KIDNEY CENTERS
Doing business as
PSKC Anacortes
Practice address
809 31St St
Anacortes, WA 98221
Phone
(360) 755-3586
Fax
(360) 982-2693
NPI assigned
Mar 14, 2014
Last updated
Feb 4, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 4, 2015

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

Authorized official

Name
Harold S Kelly
Title
President and Ceo
Phone
(425) 259-5195

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X 600401431 WA Primary

Addresses

Primary practice location

809 31St St
Anacortes, WA 98221

Mailing address

1019 Pacific Ave
Everett, WA 98201-4148
Phone (425) 259-5195

Other identifiers 2

IdentifierTypeStateIssuer
2036232MedicaidWA
50-2573OtherWAMEDICARE ID-TYPE UNSPECIFIED

Other names 1

  • PSKC Anacortes Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20140424001410 WA Part A Provider - End-Stage Renal Disease Facility (ESRD) 3476501560 Practice locations: Anacortes, WA
O20171005001174 WA Part B Supplier - Clinic/Group Practice 3476501560 Receives reassigned benefits from 1 practitioner
6 other NPIs on this enrollment
Practice locations: Arlington, WA; Everett, WA; Lakewood, WA; Monroe, WA; Mountlake Terrace, WA; Oak Harbor, WA; Anacortes, WA

Other NPIs with the same Medicare PAC ID 11

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

Other NPIs on the same Medicare enrollment 6

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Dialysis facility

Medicare Care Compare
Listed as
Puget Sound Kidney Centers AnacortesCCN 502573
Overall star rating
3.0 of 5
Ownership
Non-profit
Certified
May 14, 2014
Medicare certification status
ActiveFrom the Provider of Services file
Chain
Puget Sound Kidney Centers
Dialysis stations
8

Name & address match This facility record has no NPI; it was connected to this NPI by matching name and address.

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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.

Affiliated clinicians 2

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1394755200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1423008000000",
    "number": "1073939062",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1019 PACIFIC AVE",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982014148",
            "telephone_number": "425-259-5195",
            "fax_number": "425-259-4860"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "809 31ST ST",
            "city": "ANACORTES",
            "state": "WA",
            "postal_code": "98221",
            "telephone_number": "360-755-3586",
            "fax_number": "360-982-2693"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PUGET SOUND KIDNEY CENTERS",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-14",
        "last_updated": "2015-02-04",
        "status": "A",
        "authorized_official_last_name": "KELLY",
        "authorized_official_first_name": "HAROLD",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PRESIDENT AND CEO",
        "authorized_official_telephone_number": "425-259-5195"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "WA",
            "license": "600401431",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2036232",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID-TYPE UNSPECIFIED",
            "identifier": "50-2573",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PSKC Anacortes",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Anacortes, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 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.