Proliance Surgeons, Inc., P.S.

Primary specialty

Pediatric Sports Medicine PhysicianTaxonomy code 2080S0010X

License

601484763 Issued in WA

Legal business name

PROLIANCE SURGEONS, INC., P.S.

Practice address

3216 NE 45TH PL Ste 304
Seattle, WA 98105-4028

Phone

(206) 386-2600

Fax

(206) 622-1644

NPI assigned

Apr 2, 2015

Organization subpart

No

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

Authorized official

Name

Mrs. Laura Kleisle

Title

Chief Risk Officer

Phone

(206) 838-2590

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Orthopedic Physician Associates Doing business as

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

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

{
    "created_epoch": "1427932800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1622073600000",
    "number": "1134514433",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 BROADWAY FL 6",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981225330",
            "telephone_number": "206-386-2600",
            "fax_number": "206-622-1644"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3216 NE 45TH PL STE 304",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981054028",
            "telephone_number": "206-386-2600",
            "fax_number": "206-622-1644"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROLIANCE SURGEONS, INC., P.S.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-02",
        "last_updated": "2021-05-27",
        "certification_date": "2021-05-27",
        "status": "A",
        "authorized_official_last_name": "KLEISLE",
        "authorized_official_first_name": "LAURA",
        "authorized_official_title_or_position": "CHIEF RISK OFFICER",
        "authorized_official_telephone_number": "206-838-2590",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "2080S0010X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pediatrics, Sports Medicine",
            "state": "WA",
            "license": "601484763",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WA LABOR & INDUSTRIES",
            "identifier": "49701",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2021639",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Orthopedic Physician Associates",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Orthopedic Physician Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Proliance Surgeons Inc., P.S.
• Proliance Surgeons Inc., P.S.
• Proliance Surgeons, Inc., P.S
• Proliance Surgeons, Inc., P.S
• Proliance Surgeons, Inc., P.S.
• Proliance Surgeons, Inc., P.S.
• Proliance Surgeons, Inc., P.S.
• Proliance Surgeons, Inc., P.S.
• Proliance Surgeons, Inc., P.S.
• Proliance Surgeons, Inc., P.S.

• Pediatric Sports Medicine Physician in Seattle, WA
• Providers in Seattle, WA by specialty
• Pediatric Sports Medicine Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2021; 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.