Active NPI
Franciscan Health System
- Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
- Tacoma, WA
National Provider Identifier
1124062997
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
- Legal business name
- FRANCISCAN HEALTH SYSTEM
- Practice address
- 1802 Yakima Ave
Suite 102
Tacoma, WA 98405-4499 - Phone
- (253) 272-7777
- Fax
- (253) 426-4142
- NPI assigned
- Jun 15, 2006
- Organization subpart
- Yes
- Parent organization
- FRANCISCAN HEALTH SYSTEM
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Mike Fitzgerald
- Title
- VP Financial Ops
- Phone
- (253) 552-4105
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician | 208G00000X | Primary |
Addresses
Primary practice location
1802 Yakima Ave
Suite 102
Tacoma, WA 98405-4499
Mailing address
1802 Yakima Ave
Suite 102
Tacoma, WA 98405-4499
Phone (253) 272-7777
Other identifiers 9
| Identifier | Type | State | Issuer |
|---|---|---|---|
| CU0613 | Other | WA | MEDICARE RAILROAD |
| 8939625 | Other | WA | CRIME VICTIMS |
| 0191190 | Other | WA | STATE L&I |
| GAB07438 | Other | WA | LEGACY |
| P00625530 | Other | WA | RR MEDICARE |
| 0292620 | Other | WA | L&I |
| 7125818 | Medicaid | WA | |
| 0293927 | Other | WA | L&I |
| G8868766 | Other | WA | MEDICARE |
Other names 1
- St Joseph Cardiothoracic Surgeons
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040209000147 | WA | Part B Supplier - Clinic/Group Practice | 1557254935 |
Receives reassigned benefits from 27 practitioners 26 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Tacoma, WA; University Place, WA; Silverdale, WA; Puyallup, WA; Lakewood, WA; Gig Harbor, WA |
Other NPIs on the same Medicare enrollment 26
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
-
- Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
- Puyallup, WA
- NPI 1356687271
O20040209000147
-
- Internal Medicine Physician
- University Place, WA
- NPI 1366472508
O20040209000147
National Provider Directory
National Provider Directory- Part of
- Franciscan HLTH System West
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150329600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1341792000000",
"number": "1124062997",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1802 YAKIMA AVE",
"address_2": "SUITE 102",
"city": "TACOMA",
"state": "WA",
"postal_code": "984054499",
"telephone_number": "253-272-7777",
"fax_number": "253-426-4142"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1802 YAKIMA AVE",
"address_2": "SUITE 102",
"city": "TACOMA",
"state": "WA",
"postal_code": "984054499",
"telephone_number": "253-272-7777",
"fax_number": "253-426-4142"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "FRANCISCAN HEALTH SYSTEM",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "FRANCISCAN HEALTH SYSTEM",
"enumeration_date": "2006-06-15",
"last_updated": "2012-07-09",
"status": "A",
"authorized_official_last_name": "FITZGERALD",
"authorized_official_first_name": "MIKE",
"authorized_official_title_or_position": "VP FINANCIAL OPS",
"authorized_official_telephone_number": "253-552-4105",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "208G00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE RAILROAD",
"identifier": "CU0613",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CRIME VICTIMS",
"identifier": "8939625",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE L&I",
"identifier": "0191190",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LEGACY",
"identifier": "GAB07438",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE",
"identifier": "P00625530",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "L&I",
"identifier": "0292620",
"state": "WA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7125818",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "L&I",
"identifier": "0293927",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE",
"identifier": "G8868766",
"state": "WA"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "St Joseph Cardiothoracic Surgeons",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Tacoma, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2012; 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.