NPIMap

Organization Active NPI

Providence Health & Services-Washington

Doing business as PMG NW WA Cardiovascular and Thoracic Surgery

  • Surgery Physician
  • Everett, WA
National Provider Identifier
1114236791
Registry record updated May 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
PROVIDENCE HEALTH & SERVICES-WASHINGTON
Doing business as
PMG NW WA Cardiovascular and Thoracic Surgery
Practice address
1330 Rockefeller Avenue
Suite 400
Everett, WA 98201-1676
Phone
(425) 261-4950
Fax
(425) 261-4951
NPI assigned
Sep 30, 2010
Last updated
May 9, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 9, 2025

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

Authorized official

Name
Donald Wayne Anderson Jr.
Title
Assistant Secretary of Enrollments
Phone
(425) 358-9786

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208600000X Primary

Addresses

Primary practice location

1330 Rockefeller Avenue
Suite 400
Everett, WA 98201-1676

Mailing address

PO Box 31001-4114
Pasadena, CA 91110-4114
Phone (425) 358-9786

Other names 1

  • PMG NW WA Cardiovascular and Thoracic Surgery Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20081224000111 WA Part B Supplier - Clinic/Group Practice 8325100480 Receives reassigned benefits from 816 practitioners
34 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment

Other NPIs on the same Medicare enrollment 34

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

View all 34

National Provider Directory

National Provider Directory
Tax ID family
PMG NW Wa Cardiology13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

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

Locations

12800 Bothell Everett Hwy
Ste 270
Everett, WA 98208
Phone (425) 316-5100

Practitioners & affiliated clinicians

Practitioners 16

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 16

NPI Registry JSON

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

{
    "created_epoch": "1285804800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1746748800000",
    "number": "1114236791",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 31001-4114",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911104114",
            "telephone_number": "425-358-9786"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1330 ROCKEFELLER AVENUE",
            "address_2": "SUITE 400",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982011676",
            "telephone_number": "425-261-4950",
            "fax_number": "425-261-4951"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE HEALTH & SERVICES-WASHINGTON",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-09-30",
        "last_updated": "2025-05-09",
        "certification_date": "2025-05-09",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "WAYNE",
        "authorized_official_title_or_position": "ASSISTANT SECRETARY OF ENROLLMENTS",
        "authorized_official_telephone_number": "425-358-9786",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PMG NW WA Cardiovascular and Thoracic Surgery",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "PMG NW WA Cardiovascular and Thoracic Surgery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Everett, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2025; 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.