NPIMap

Organization Active NPI

Proliance Surgeons, Inc., P.S.

  • Ambulatory Surgical Clinic/Center
  • Puyallup, WA
National Provider Identifier
1083622112
Registry record updated May 27, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
Legal business name
PROLIANCE SURGEONS, INC., P.S.
Practice address
1519 3Rd St SE
Suite 240
Puyallup, WA 98372-3742
Phone
(253) 445-1844
NPI assigned
Aug 4, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 27, 2021

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

Authorized official

Name
Mrs. Laura Kleisle
Title
Chief Risk Officer
Phone
(206) 838-2590

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X Primary

Addresses

Primary practice location

1519 3Rd St SE
Suite 240
Puyallup, WA 98372-3742

Mailing address

1519 3Rd St SE Ste 210
Puyallup, WA 98372-3742

Other identifiers 2

IdentifierTypeStateIssuer
2041039MedicaidWA
334863OtherWAWA LABOR & INDUSTRIES

Other names 1

  • Puyallup Ambulatory Surgery Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031208000102 WA Part B Supplier - Ambulatory Surgical Center 8527972900 14 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Kirkland, WA

Other NPIs on the same Medicare enrollment 14

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

View all 14

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Puyallup Ambulatory Surgery CenterCCN 50C0001221
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory

Locations

202 N Division St
Ste 403A
Auburn, WA 98001
Phone (253) 841-9640

1519 3rd St SE
Ste 230
Puyallup, WA 98372
Phone (253) 697-7100

Practitioners & affiliated clinicians

Practitioners 4

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

NPI Registry JSON

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

{
    "created_epoch": "1154649600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1622073600000",
    "number": "1083622112",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1519 3RD ST SE STE 210",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983723742"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1519 3RD ST SE",
            "address_2": "SUITE 240",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983723742",
            "telephone_number": "253-445-1844"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROLIANCE SURGEONS, INC., P.S.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-04",
        "last_updated": "2021-05-27",
        "certification_date": "2021-05-27",
        "status": "A",
        "authorized_official_last_name": "KLEISLE",
        "authorized_official_first_name": "LAURA",
        "authorized_official_title_or_position": "CHIEF RISK OFFICER",
        "authorized_official_telephone_number": "206-838-2590",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2041039",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WA LABOR & INDUSTRIES",
            "identifier": "334863",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Puyallup Ambulatory Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Puyallup Ambulatory Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Puyallup, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2021; 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.