NPIMap

Organization Active NPI

Western Washington Medical Group, Inc PS

  • Family Medicine Physician
  • Arlington, WA
National Provider Identifier
1134460959
Registry record updated Feb 23, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
WESTERN WASHINGTON MEDICAL GROUP, INC PS
Practice address
875 Wesley St
Suite 250
Arlington, WA 98223-1613
Phone
(425) 259-4041
NPI assigned
Mar 4, 2013
Organization subpart
Yes
Parent organization
WESTERN WASHINGTON MEDICAL GROUP, INC, PSAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 23, 2016

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

Authorized official

Name
Kimberly K Holstein
Title
Director PFS
Phone
(425) 259-4041

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

875 Wesley St
Suite 250
Arlington, WA 98223-1613

Mailing address

1728 W Marine View Dr
Suite 110
Everett, WA 98201-2094
Phone (425) 259-4041

Other names 1

  • Whitehorse Family Medicine Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031107000469 WA Part B Supplier - Clinic/Group Practice 7517870314 Receives reassigned benefits from 130 practitioners
32 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Everett, WA; Lynnwood, WA; Marysville, WA; Monroe, WA; Oak Harbor, WA; Snohomish, WA; Anacortes, WA; Arlington, WA…

Other NPIs on the same Medicare enrollment 32

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

View all 32

National Provider Directory

National Provider Directory
Part of
Western Washington Med GRP

Locations

620 Hazel St
Arlington, WA 98223
Phone (360) 403-8247

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1362355200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1456185600000",
    "number": "1134460959",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1728 W MARINE VIEW DR",
            "address_2": "SUITE 110",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982012094",
            "telephone_number": "425-259-4041",
            "fax_number": "425-252-6642"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "875 WESLEY ST",
            "address_2": "SUITE 250",
            "city": "ARLINGTON",
            "state": "WA",
            "postal_code": "982231613",
            "telephone_number": "425-259-4041"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WESTERN WASHINGTON MEDICAL GROUP, INC PS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WESTERN WASHINGTON MEDICAL GROUP, INC, PS",
        "enumeration_date": "2013-03-04",
        "last_updated": "2016-02-23",
        "status": "A",
        "authorized_official_last_name": "HOLSTEIN",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "DIRECTOR PFS",
        "authorized_official_telephone_number": "425-259-4041"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Whitehorse Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Arlington, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2016; 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.