Organization Active NPI

Providence Health & Services- Washington

  • General Practice Physician
  • Everett, WA
National Provider Identifier
1124270715
Registry record updated Feb 19, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
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

Updated by the provider on Feb 19, 2026

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)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X Primary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 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 Doing business as
  • PROVIDENCE MEDICAL GROUP NORTHWEST WASHINGTON Doing business as

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, NJ24 enrollments

Enrollment records 24

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
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.

View all 34

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
50D0633805PMG NW Wa Pacific OB/GYN900 Pacific Ave Ste 501, Everett, WA 98201Certificate of waiverApr 4, 2028

National Provider Directory

National Provider Directory

Locations

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.

View all 974

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

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.

Verify at the official NPI Registry.