NPIMap

Organization Active NPI

Pain Care Physicians PLLC

  • Interventional Pain Medicine Physician
  • Renton, WA
National Provider Identifier
1144779232
Registry record updated Jul 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X
Legal business name
PAIN CARE PHYSICIANS PLLC
Practice address
801 SW 16TH St
Suite 121
Renton, WA 98057
Phone
(206) 538-6300
Fax
(206) 538-6301
NPI assigned
Sep 29, 2016
Last updated
Jul 21, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2025

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

Authorized official

Name
Kevin Brian Moon
Title
Director of Revenue and Finance
Phone
(206) 538-6300

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 208VP0000X
Interventional Pain Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 208VP0014X Primary
Ambulatory Surgical Clinic/Center 261QA1903X

Addresses

Primary practice location

801 SW 16TH St
Suite 121
Renton, WA 98057

Mailing address

801 SW 16TH St
Suite 121
Renton, WA 98057
Phone (206) 538-6300

Other practice location 1

1415 N Houk Rd Ste B
Spokane Valley, WA 99216-1043
Phone (509) 381-4500

Other practice location 2

155 Lilly Rd NE Ste B
Olympia, WA 98506-5028
Phone (206) 538-6300

Other identifiers 2

IdentifierTypeStateIssuer
50C0001329OtherWAMEDICARE CERTIFICATION NUMBER
50C0001354OtherWAMEDICARE CERTIFICATION NUMBER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA4 enrollments

Enrollment records 4

Enrollment IDStateProvider typePAC IDDetails
O20161107001926 WA Part B Supplier - Clinic/Group Practice 9537448931 Receives reassigned benefits from 18 practitioners
7 other NPIs on this enrollment
Practice locations: Everett, WA; Bellevue, WA; Tacoma, WA; Spokane Valley, WA; Olympia, WA; Renton, WA
O20180511000695 WA DME Supplier - Physician - Interventional Pain Management 9537448931 Practice locations: Renton, WA
O20200424000295 WA Part B Supplier - Ambulatory Surgical Center 9537448931 Receives reassigned benefits from 6 practitioners
Practice locations: Olympia, WA
O20240731000840 WA Part B Supplier - Ambulatory Surgical Center 9537448931 Receives reassigned benefits from 5 practitioners
Practice locations: Spokane Valley, WA

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 6

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

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Pain Care Physicians PLLCCCN 50C0001329
Medicare certification status
ActiveFrom the Provider of Services file

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
50D2122658Pain Care Physicians801 SW 16TH St Ste 121, Renton, WA 98057Certificate of waiverApr 4, 2028

National Provider Directory

National Provider Directory

Locations

1260 116th Ave NE
Ste 130
Bellevue, WA 98004

11611 Airport Rd
Ste 101
Everett, WA 98204
Phone (206) 805-8885

155 Lilly Rd NE
Olympia, WA 98506

155 Lilly Rd NE
Ste A
Olympia, WA 98506
Phone (206) 895-1825

1628 S Mildred St
Ste 102
Tacoma, WA 98465
Phone (206) 895-1825

Practitioners & affiliated clinicians

Practitioners 18

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 18

NPI Registry JSON

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

{
    "created_epoch": "1475107200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1753056000000",
    "number": "1144779232",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 SW 16TH ST",
            "address_2": "SUITE 121",
            "city": "RENTON",
            "state": "WA",
            "postal_code": "98057",
            "telephone_number": "206-538-6300",
            "fax_number": "206-538-6301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 SW 16TH ST",
            "address_2": "SUITE 121",
            "city": "RENTON",
            "state": "WA",
            "postal_code": "98057",
            "telephone_number": "206-538-6300",
            "fax_number": "206-538-6301"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1415 N Houk Rd Ste B",
            "address_purpose": "LOCATION",
            "city": "Spokane Valley",
            "state": "WA",
            "postal_code": "992161043",
            "country_code": "US",
            "telephone_number": "509-381-4500",
            "fax_number": "509-381-4501",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "155 Lilly Rd NE Ste B",
            "address_purpose": "LOCATION",
            "city": "Olympia",
            "state": "WA",
            "postal_code": "985065028",
            "country_code": "US",
            "telephone_number": "206-538-6300",
            "fax_number": "206-538-6301",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PAIN CARE PHYSICIANS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-29",
        "last_updated": "2025-07-21",
        "certification_date": "2025-07-21",
        "status": "A",
        "authorized_official_last_name": "MOON",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "BRIAN",
        "authorized_official_title_or_position": "DIRECTOR OF REVENUE AND FINANCE",
        "authorized_official_telephone_number": "206-538-6300"
    },
    "taxonomies": [
        {
            "code": "208VP0000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pain Medicine, Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE CERTIFICATION NUMBER",
            "identifier": "50C0001329",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE CERTIFICATION NUMBER",
            "identifier": "50C0001354",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Renton, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2025; 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.