Active NPI
Providence Health & Services- Washington
- General Practice Physician
- Everett, WA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Physician
- Legal business name
- PROVIDENCE HEALTH & SERVICES- WASHINGTON
- Practice address
- 900 Pacific Ave
Ste 501
Everett, WA 98201-4168 - Phone
- (425) 258-7550
- Fax
- (425) 258-7450
- NPI assigned
- Oct 15, 2008
- Organization subpart
- No
NPPES NPI Registry
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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | |||
| General Practice Physician | 208D00000X | Primary | ||
| Physical Therapist | 225100000X |
Addresses
Primary practice location
900 Pacific Ave
Ste 501
Everett, WA 98201-4168
Mailing address
PO Box 31001-4114
Pasadena, CA 91110-4114
Phone (425) 358-9786
Other names 2
- PMG NW WA
- PROVIDENCE MEDICAL GROUP NORTHWEST WASHINGTON
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WA, OR, CO, AK, CA, MI, MT, HI, NV, MO, FL, NY, DC, TX, ID, MN, AZ, IL, NE, TN, WI, UT, NC, NJ
Enrollment records 24
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20081224000111 | WA | Part B Supplier - Clinic/Group Practice | 8325100480 |
Receives reassigned benefits from 816 practitioners 34 other NPIs on this enrollment |
| O20190103000011 | OR | Part B Supplier - Clinic/Group Practice | 8325100480 |
Receives reassigned benefits from 24 practitioners Practice locations: Portland, OR; Astoria, OR; Beaverton, OR; Bend, OR; Corvallis, OR; Happy Valley, OR; Hood River, OR; Medford, OR… |
| O20190118000527 | CO | Part B Supplier - Clinic/Group Practice | 8325100480 |
Receives reassigned benefits from 1 practitioner Practice locations: Frisco, CO |
| O20190131000417 | AK | Part B Supplier - Clinic/Group Practice | 8325100480 |
Receives reassigned benefits from 5 practitioners Practice locations: Anchorage, AK |
| O20190204000924 | CA | Part B Supplier - Clinic/Group Practice | 8325100480 |
Receives reassigned benefits from 21 practitioners Practice locations: Pico Rivera, CA; Los Angeles, CA; Redlands, CA; Riverside, CA; San Diego, CA; San Jose, CA; Simi Valley, CA; Sylmar, CA… |
| O20200327001316 | MI | Part B Supplier - Clinic/Group Practice | 8325100480 |
Receives reassigned benefits from 4 practitioners Practice locations: Hudsonville, MI; Shelby, MI; Saint Clair Shores, MI; Ludington, MI; Ada, MI; Hart, MI |
| O20200420000686 | MT | Part B Supplier - Clinic/Group Practice | 8325100480 |
Receives reassigned benefits from 6 practitioners Practice locations: Lolo, MT; Missoula, MT |
| O20201001001126 | HI | Part B Supplier - Clinic/Group Practice | 8325100480 |
Receives reassigned benefits from 1 practitioner Practice locations: Honolulu, HI |
| O20201007002636 | NV | Part B Supplier - Clinic/Group Practice | 8325100480 |
Receives reassigned benefits from 4 practitioners Practice locations: Reno, NV |
| O20201008000150 | MO | Part B Supplier - Clinic/Group Practice | 8325100480 |
Receives reassigned benefits from 1 practitioner Practice locations: Manchester, MO |
| O20201013003509 | FL | Part B Supplier - Clinic/Group Practice | 8325100480 |
Receives reassigned benefits from 2 practitioners Practice locations: Miami, FL |
| O20201019000601 | NY | Part B Supplier - Clinic/Group Practice | 8325100480 |
Receives reassigned benefits from 3 practitioners Practice locations: Brooklyn, NY; Syosset, NY; White Plains, NY |
| O20201026001461 | DC | Part B Supplier - Clinic/Group Practice | 8325100480 |
Receives reassigned benefits from 1 practitioner Practice locations: Bowie, MD |
| O20210427001047 | TX | Part B Supplier - Clinic/Group Practice | 8325100480 |
Receives reassigned benefits from 8 practitioners Practice locations: Allen, TX; Friendswood, TX; Frisco, TX; Houston, TX; Irving, TX; Westlake, TX |
| O20220303001998 | ID | Part B Supplier - Clinic/Group Practice | 8325100480 |
Receives reassigned benefits from 2 practitioners Practice locations: Boise, ID; Kuna, ID |
| O20230105003266 | MN | Part B Supplier - Clinic/Group Practice | 8325100480 |
Receives reassigned benefits from 1 practitioner Practice locations: Minneapolis, MN |
| O20230711003097 | AZ | Part B Supplier - Clinic/Group Practice | 8325100480 |
Receives reassigned benefits from 1 practitioner Practice locations: Green Valley, AZ |
| O20240112002258 | IL | Part B Supplier - Clinic/Group Practice | 8325100480 |
Receives reassigned benefits from 2 practitioners Practice locations: Oak Brook, IL; Park Ridge, IL |
| O20240617002732 | NE | Part B Supplier - Clinic/Group Practice | 8325100480 |
Receives reassigned benefits from 1 practitioner Practice locations: Elkhorn, NE |
| O20240910000833 | TN | Part B Supplier - Clinic/Group Practice | 8325100480 |
Receives reassigned benefits from 2 practitioners Practice locations: Memphis, TN |
| O20241009000596 | WI | Part B Supplier - Clinic/Group Practice | 8325100480 |
Receives reassigned benefits from 1 practitioner Practice locations: Williams Bay, WI |
| O20250408001693 | UT | Part B Supplier - Clinic/Group Practice | 8325100480 |
Receives reassigned benefits from 2 practitioners Practice locations: Hurricane, UT; St George, UT |
| O20250623000461 | NC | Part B Supplier - Clinic/Group Practice | 8325100480 |
Receives reassigned benefits from 1 practitioner Practice locations: Huntersville, NC |
| O20251210003497 | NJ | Part B Supplier - Clinic/Group Practice | 8325100480 |
Receives reassigned benefits from 1 practitioner Practice locations: Hillside, NJ |
Other NPIs on the same Medicare enrollment 34
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
-
- General Practice Physician
- Mukilteo, WA
- NPI 1003050709
O20081224000111
-
- Neurological Surgery Physician
- Everett, WA
- NPI 1144471533
O20081224000111
-
- Family Medicine Physician
- Everett, WA
- NPI 1255582649
O20081224000111
-
- Cardiovascular Disease Physician
- Mukilteo, WA
- NPI 1669616363
O20081224000111
-
- Neurological Surgery Physician
- Everett, WA
- NPI 1760633879
O20081224000111
-
- Advanced Practice Midwife
- Everett, WA
- NPI 1861622557
O20081224000111
-
- General Practice Physician
- Everett, WA
- NPI 1013169507
O20081224000111
-
- Family Medicine Physician
- Marysville, WA
- NPI 1063663458
O20081224000111
-
- Family Medicine Physician
- Mukilteo, WA
- NPI 1124279237
O20081224000111
-
- Internal Medicine Physician
- Everett, WA
- NPI 1154572253
O20081224000111
-
- Family Medicine Physician
- Monroe, WA
- NPI 1225289333
O20081224000111
-
- Vascular Surgery Physician
- Everett, WA
- NPI 1225335425
O20081224000111
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 50D0633805 | PMG NW Wa Pacific OB/GYN | Certificate of waiver | Apr 4, 2028 |
National Provider Directory
National Provider DirectoryLocations
1330 Rockefeller Ave
Ste 450
Everett, WA 98201
Phone (206) 258-6801
13020 Meridian Ave S
Ste 203
Everett, WA 98208
Phone (425) 357-3700
13020 Meridian Ave S
Ste 201
Everett, WA 98208
Phone (425) 357-3700
12800 Bothell Everett Hwy
Ste 250
Everett, WA 98208
Phone (425) 316-5410
13020 Meridian Ave S
Ste 202
Everett, WA 98208
Phone (425) 357-3700
1330 Rockefeller Ave
#230
Everett, WA 98201
Phone (425) 261-4923
13020 Meridian Ave S
Ste 205
Everett, WA 98208
Phone (425) 316-5155
1330 Rockefeller Ave
Ste 220
Everett, WA 98201
Phone (425) 261-4920
12333 NE 130th Ln
Ste 210
Kirkland, WA 98034
Phone (425) 261-4950
12040 NE 128th St
Ste 100
Kirkland, WA 98034
Phone (425) 899-1000
2902 164th St SW
Bldg E
Lynnwood, WA 98087
11604 State Ave Ste G
Marysville, WA 98271
3525 Ensign Rd NE
Ste R
Olympia, WA 98506
Phone (360) 459-3663
5300 Tallman Ave NW
#4
Seattle, WA 98107
Phone (206) 297-5100
425 Pontius Ave N
Ste 300
Seattle, WA 98109
Phone (206) 320-4000
105 W 8th Ave
#122C
Spokane, WA 99204
7209 265th St NW
Ste 203
Stanwood, WA 98292
Phone (360) 658-6800
Practitioners & affiliated clinicians
Practitioners 974
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Emergency Medical Services (Emergency Medicine) Physician
- Everett, WA
- NPI 1982458030
WA
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1224028800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1771459200000",
"number": "1124270715",
"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": "900 PACIFIC AVE",
"address_2": "STE 501",
"city": "EVERETT",
"state": "WA",
"postal_code": "982014168",
"telephone_number": "425-258-7550",
"fax_number": "425-258-7450"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PROVIDENCE HEALTH & SERVICES- WASHINGTON",
"organizational_subpart": "NO",
"enumeration_date": "2008-10-15",
"last_updated": "2026-02-19",
"certification_date": "2026-02-19",
"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": "1041C0700X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Social Worker, Clinical",
"state": null,
"license": null,
"primary": false
},
{
"code": "208D00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "General Practice",
"state": null,
"license": null,
"primary": true
},
{
"code": "225100000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Physical Therapist",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "PMG NW WA",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "PMG NW WA",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "PROVIDENCE MEDICAL GROUP NORTHWEST WASHINGTON",
"code": "3",
"type": "Doing Business As"
}
]
}
Other providers in Everett, WA
- Providence Health & Services - Washington
- Providence Health & Services - Washington
- Providence Health & Services - Washington
- Providence Health & Services - Washington
- Providence Health & Services Washington
- Providence Health & Services-Wa
- Providence Health & Services-Wa
- Providence Health & Services-Wa
- Providence Health & Services-Wa
- Providence Health & Services-Wa
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2026; 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.