NPIMap

Organization Active NPI

Evergreen Eye Anesthesia PLLC

  • Certified Registered Nurse Anesthetist
  • Federal Way, WA
National Provider Identifier
1134839319
Registry record updated Dec 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
Legal business name
EVERGREEN EYE ANESTHESIA PLLC
Practice address
34719 6TH Ave S
Federal Way, WA 98003-8714
Phone
(800) 340-3595
NPI assigned
Nov 29, 2022
Last updated
Dec 15, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 15, 2022

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

Authorized official

Name
Suzanne Isom
Title
Billing Manager
Phone
(425) 407-1000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse AnesthetistGroup: 193400000X SINGLE SPECIALTY GROUP 367500000X Primary

Addresses

Primary practice location

34719 6TH Ave S
Federal Way, WA 98003-8714

Mailing address

6003 23Rd Dr W Ste 100
Everett, WA 98203-1583
Phone (425) 407-1500

Other practice location 1

502 S M St
Tacoma, WA 98405-3728
Phone (800) 340-3595

Other practice location 2

1229 Madison St Ste 1250
Seattle, WA 98104-3568
Phone (206) 212-2100

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230111001798 WA Part B Supplier - Clinic/Group Practice 7315317112 Receives reassigned benefits from 22 practitioners
Practice locations: Federal Way, WA; Seattle, WA; Tacoma, WA

National Provider Directory

National Provider Directory

Locations

6003 23rd Dr W
Ste 100
Everett, WA 98203

Practitioners & affiliated clinicians

Practitioners 24

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1669680000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1671062400000",
    "number": "1134839319",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6003 23RD DR W STE 100",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982031583",
            "telephone_number": "425-407-1500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "34719 6TH AVE S",
            "city": "FEDERAL WAY",
            "state": "WA",
            "postal_code": "980038714",
            "telephone_number": "800-340-3595"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "502 S M St",
            "address_purpose": "LOCATION",
            "city": "Tacoma",
            "state": "WA",
            "postal_code": "984053728",
            "country_code": "US",
            "telephone_number": "800-340-3595",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1229 Madison St Ste 1250",
            "address_purpose": "LOCATION",
            "city": "Seattle",
            "state": "WA",
            "postal_code": "981043568",
            "country_code": "US",
            "telephone_number": "206-212-2100",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "EVERGREEN EYE ANESTHESIA PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-11-29",
        "last_updated": "2022-12-15",
        "certification_date": "2022-12-15",
        "status": "A",
        "authorized_official_last_name": "ISOM",
        "authorized_official_first_name": "SUZANNE",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "425-407-1000"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Federal Way, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2022; 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.