Individual provider Active NPI

Angela A Viniarski, M.D.

  • Pediatrics Physician
  • Puyallup, WA
National Provider Identifier
1093793960
Registry record updated Nov 10, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
MD00044075 Issued in WA
Practice address
1706 Meridian S
Suite 120
Puyallup, WA 98371-7516
Phone
(253) 848-8797
Fax
(253) 446-3239
NPI assigned
Jan 2, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 10, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X MD00044075 WA Primary

Addresses

Primary practice location

1706 Meridian S
Suite 120
Puyallup, WA 98371-7516

Mailing address

1706 Meridian S
Suite 120
Puyallup, WA 98371-7516
Phone (253) 848-8797

Other identifiers 1

IdentifierTypeStateIssuer
8403024OtherWADSHS NUMBER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180123001048 WA Practitioner - Pediatric Medicine 3779842661 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD00044075WAMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Multicare Health System CurrentSince Jan 1, 2018 Accepting new patients
Multicare Health System Current Accepting new patients
Multicare Health System CurrentSince Jan 1, 2018 Accepting new patients

Locations

4700 Point Fosdick Dr
Ste 104
Gig Harbor, WA 98335
Phone (253) 459-7590

222 State Ave N
Kent, WA 98030
Phone (253) 372-7680

1706 S Meridian
Ste 120
Puyallup, WA 98371
Phone (253) 848-8797

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1136160000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1320883200000",
    "number": "1093793960",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1706 MERIDIAN S",
            "address_2": "SUITE 120",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983717516",
            "telephone_number": "253-848-8797",
            "fax_number": "253-446-3239"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1706 MERIDIAN S",
            "address_2": "SUITE 120",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983717516",
            "telephone_number": "253-848-8797",
            "fax_number": "253-446-3239"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VINIARSKI",
        "first_name": "ANGELA",
        "middle_name": "A",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-02",
        "last_updated": "2011-11-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "WA",
            "license": "MD00044075",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DSHS NUMBER",
            "identifier": "8403024",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Puyallup, WA

Sources for this page

Verify at the official NPI Registry.