NPIMap

Organization Active NPI

Puget Sound Kidney Centers

Doing business as PSKC - South

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Mountlake Terrace, WA
National Provider Identifier
1093835811
Registry record updated Feb 5, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
Legal business name
PUGET SOUND KIDNEY CENTERS
Doing business as
PSKC - South
Practice address
21309 44TH Ave W
Mountlake Terrace, WA 98043-3507
Phone
(425) 744-1095
Fax
(425) 775-1144
NPI assigned
Mar 29, 2007
Last updated
Feb 5, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 5, 2008

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

Authorized official

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

Specialties & licenses 1

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

Addresses

Primary practice location

21309 44TH Ave W
Mountlake Terrace, WA 98043-3507

Mailing address

1005 Pacific Ave
Everett, WA 98201-4148
Phone (425) 259-5195

Other identifiers 1

IdentifierTypeStateIssuer
3144805MedicaidWA

Other names 1

  • PSKC - SOUTH Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20110622000130 WA Part A Provider - End-Stage Renal Disease Facility (ESRD) 3476501560 Practice locations: Mountlake Terrace, WA
O20171005001174 WA Part B Supplier - Clinic/Group Practice 3476501560 Receives reassigned benefits from 1 practitioner
6 other NPIs on this enrollment
This NPI is an additional NPI on the 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 KC SouthCCN 502521
Overall star rating
4.0 of 5
Ownership
Non-profit
Certified
Aug 6, 1997
Medicare certification status
ActiveFrom the Provider of Services file
Chain
Puget Sound Kidney Centers
Dialysis stations
32

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
Tax ID family
Puget Sound Kidney Centers11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Affiliated clinicians 7

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": "1175126400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1202169600000",
    "number": "1093835811",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1005 PACIFIC AVE",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982014148",
            "telephone_number": "425-259-5195",
            "fax_number": "425-259-4890"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21309 44TH AVE W",
            "city": "MOUNTLAKE TERRACE",
            "state": "WA",
            "postal_code": "980433507",
            "telephone_number": "425-744-1095",
            "fax_number": "425-775-1144"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PUGET SOUND KIDNEY CENTERS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-29",
        "last_updated": "2008-02-05",
        "status": "A",
        "authorized_official_last_name": "KELLY",
        "authorized_official_first_name": "HAROLD",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PRESIDENT & 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": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3144805",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PSKC - SOUTH",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mountlake Terrace, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2008; 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.