NPIMap

Organization Active NPI

Proliance Surgeons Inc P S

  • Orthopaedic Surgery Physician
  • Issaquah, WA
National Provider Identifier
1124500293
Registry record updated Oct 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License
601484763 Issued in WA
Legal business name
PROLIANCE SURGEONS INC P S
Practice address
510 8TH Ave NE Ste 200
Issaquah, WA 98029-5436
Phone
(425) 392-3030
Fax
(425) 392-2564
NPI assigned
Sep 5, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2025

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

Authorized official

Name
Mr. Kenneth G. Overbey
Title
Coo
Phone
(206) 838-2583

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207X00000X 601484763 WA Primary
Physical Medicine & Rehabilitation PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208100000X 601484763 WA
Surgical Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363AS0400X 601484763 WA

Addresses

Primary practice location

510 8TH Ave NE Ste 200
Issaquah, WA 98029-5436

Mailing address

510 8TH Ave NE Ste 320
Issaquah, WA 98029-5436
Phone (425) 507-0733

Other identifiers 2

IdentifierTypeStateIssuer
2016746MedicaidWA
122274OtherWALABOR & INDUSTRIES

Other names 1

  • PROLIANCE ORTHOPAEDICS AND SPORTS MEDICINE Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190319002382 WA DME Supplier - Physician - Orthopedic/Orthopedic SurgeryDME Supplier - Multi-Specialty - PhysicianDME Supplier - Physician Assistant 8527972900 Practice locations: Issaquah, WA

National Provider Directory

National Provider Directory
Tax ID family
Orthopedic Physicians46 organizations share this tax ID, including this one

Other organizations with this tax ID 45

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

View all 45

NPI Registry JSON

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

{
    "created_epoch": "1536105600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1761782400000",
    "number": "1124500293",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "510 8TH AVE NE STE 320",
            "city": "ISSAQUAH",
            "state": "WA",
            "postal_code": "980295436",
            "telephone_number": "425-507-0733",
            "fax_number": "425-283-5551"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "510 8TH AVE NE STE 200",
            "city": "ISSAQUAH",
            "state": "WA",
            "postal_code": "980295436",
            "telephone_number": "425-392-3030",
            "fax_number": "425-392-2564"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROLIANCE SURGEONS INC P S",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-09-05",
        "last_updated": "2025-10-30",
        "certification_date": "2025-10-30",
        "status": "A",
        "authorized_official_last_name": "OVERBEY",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "G.",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "206-838-2583",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery",
            "state": "WA",
            "license": "601484763",
            "primary": true
        },
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "WA",
            "license": "601484763",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant, Surgical",
            "state": "WA",
            "license": "601484763",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2016746",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LABOR & INDUSTRIES",
            "identifier": "122274",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PROLIANCE ORTHOPAEDICS AND SPORTS MEDICINE",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "PROLIANCE ORTHOPAEDICS AND SPORTS MEDICINE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Issaquah, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 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.