NPIMap

Organization Active NPI

Optum Care Washington PLLC

  • Ambulatory Surgical Clinic/Center
  • Everett, WA
National Provider Identifier
1154318103
Registry record updated Apr 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
Legal business name
OPTUM CARE WASHINGTON PLLC
Practice address
3927 Rucker Ave
Suite101
Everett, WA 98201-4833
Phone
(425) 317-3950
NPI assigned
Oct 4, 2005
Last updated
Apr 8, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
EVERETT PHYSICIANS, INC. P.S.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 8, 2024

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

Authorized official

Name
George Go, MDNPI 1447353693
Title
Board President
Phone
(425) 259-0966

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X Primary
Durable Medical Equipment & Medical Supplies 332B00000X

Addresses

Primary practice location

3927 Rucker Ave
Suite101
Everett, WA 98201-4833

Mailing address

PO Box 5127
Everett, WA 98206-5127
Phone (425) 317-3950

Other names 1

  • Optum - Kemp Surgery Center Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040210000570 WA Part B Supplier - Ambulatory Surgical Center 6406752153 Receives reassigned benefits from 3 practitioners
1 other NPI on this enrollment
Practice locations: Everett, WA
O20111219000873 WA DME Supplier - Ambulatory Surgical Center 6406752153 Practice locations: Everett, WA

Other NPIs with the same Medicare PAC ID 19

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

View all 19

Other NPIs on the same Medicare enrollment 1

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

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
The Everett ClinicCCN 50C0001146
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
James Whainer30 organizations share this tax ID, including this one

Other organizations with this tax ID 29

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

View all 29

Locations

912 32nd St
Anacortes, WA 98221
Phone (360) 293-4343

3130 Ellis St
Bellingham, WA 98225
Phone (360) 734-4404

18505 Bothell Way NE
Ste 215
Bothell, WA 98011
Phone (425) 595-3830

1321 Colby Ave
Fl 3
Everett, WA 98201

1330 Rockefeller Ave
Ste 120
Everett, WA 98201
Phone (425) 339-5422

3802 Colby Ave
Everett, WA 98201
Phone (425) 252-0311

3827 Rucker Ave
Everett, WA 98201

3903 Colby Ave
Everett, WA 98201
Phone (206) 252-3937

3927 Rucker Ave
Ste 101
Everett, WA 98201
Phone (425) 317-3950

4027 Hoyt Ave
Ste 104
Everett, WA 98201
Phone (425) 339-5489

7600 Evergreen Way
Everett, WA 98203
Phone (425) 259-1180

11800 NE 128th St
Fl 5
Kirkland, WA 98034
Phone (425) 899-5200

8910 Vernon Rd
Lake Stevens, WA 98258
Phone (425) 397-1700

2901 174th St NE
Marysville, WA 98271
Phone (360) 454-1900

1025 153rd St SE
Mill Creek, WA 98012
Phone (425) 338-4000

15418 Main St
#200
Mill Creek, WA 98012
Phone (425) 225-8000

15418 Main St
Ste 200
Mill Creek, WA 98012
Phone (425) 225-8000

15418 Main St
Ste 303A
Mill Creek, WA 98012
Phone (425) 225-8000

15418 Main St
Unit 303A
Mill Creek, WA 98012

15418 Main St
Unit M303
Mill Creek, WA 98012
Phone (425) 225-8003

4430 106th St SW
Mukilteo, WA 98275
Phone (425) 493-6000

1229 Madison St
Fl 9
Seattle, WA 98104

509 Olive Way
Ste 200
Seattle, WA 98101
Phone (206) 860-2210

Practitioners & affiliated clinicians

Practitioners 700

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 700

NPI Registry JSON

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

{
    "created_epoch": "1128384000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712534400000",
    "number": "1154318103",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5127",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982065127",
            "telephone_number": "425-317-3950"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3927 RUCKER AVE",
            "address_2": "SUITE101",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982014833",
            "telephone_number": "425-317-3950"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTUM CARE WASHINGTON PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EVERETT PHYSICIANS, INC. P.S.",
        "enumeration_date": "2005-10-04",
        "last_updated": "2024-04-08",
        "certification_date": "2024-04-08",
        "status": "A",
        "authorized_official_last_name": "GO",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_title_or_position": "BOARD PRESIDENT",
        "authorized_official_telephone_number": "425-259-0966",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Optum - Kemp Surgery Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Everett, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2024; 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.