Providence Health & Services Washington

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

PROVIDENCE HEALTH & SERVICES WASHINGTON

Doing business as

Providence Medical Group SouthWest Washington

Practice address

525 Lilly Rd NE
Olympia, WA 98506

Phone

(360) 793-7230

NPI assigned

May 2, 2007

Last updated

May 12, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Donald Wayne Anderson Jr.

Title

Assistant Secretary of Enrollments

Phone

(425) 358-9786

Specialties & licenses 7

Addresses

Other names 1

• Providence Medical Group SouthWest Washington Doing business as

Medicare fee-for-service enrollment

Enrolled in WA, CA, OR, AK, CO, MT, FL, HI, MO, NY, NV, DC, MI, TX, ID, MN, AZ, IL, NE, WI, UT, NC, TN, NJ24 enrollments

Enrollment records 24

Other NPIs with the same Medicare PAC ID 2

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

• Providence Health & Services Washington

  dba Providence Medical Group SW WA - MDPP

  • Clinic/Center
  • Lacey, WA
  • NPI 1215431697

  6709782600

  Same PAC ID
• Providence Health & Services Washington

  dba PMG SW Wa

  • Rural Health Clinic/Center
  • Centralia, WA
  • NPI 1225763949

  6709782600

  Same PAC ID

Other NPIs on the same Medicare enrollment 2

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

• Providence Health & Services Washington

  dba Providence Medical Group Southwest Washington

  • General Practice Physician
  • Olympia, WA
  • NPI 1134656135

  O20031211000028

  Same enrollment
• Providence Health & Services Washington

  dba PMG SW Wa

  • Rural Health Clinic/Center
  • Centralia, WA
  • NPI 1225763949

  O20031211000028

  Same enrollment

Locations

Practitioners 827

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.

• Ahmad Abadullah, MD

  • Internal Medicine Physician
  • University Place, WA
  • NPI 1225005721
  Medicare reassignment Care Compare group NPD
• Joonis Abdulkhader, M.D.

  • Family Medicine Physician
  • Seattle, WA
  • NPI 1518154335
  Medicare reassignment Care Compare group NPD
• Alexander E Abdullayev, MD

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Olympia, WA
  • NPI 1538693015
  Medicare reassignment Care Compare group NPD
• Jordan M Abel, MD

  • Family Medicine Physician
  • Rochester, WA
  • NPI 1821438029
  Medicare reassignment Care Compare group NPD
• Heshani W Abeysundara, M.D.

  • Family Medicine Physician
  • Olympia, WA
  • NPI 1205218153
  Medicare reassignment Care Compare group NPD
• Waleed Abraham, MD

  • Internal Medicine Physician
  • Olympia, WA
  • NPI 1871567495
  Medicare reassignment Care Compare group NPD
• Amanda Achterman, DO

  • Family Medicine Physician
  • Olympia, WA
  • NPI 1730593104
  Medicare reassignment Care Compare group NPD
• Crystal Lynn Adams, MD

  • Gynecologic Oncology Physician
  • Lacey, WA
  • NPI 1013111608

  Obstetrics & Gynecology

  Medicare reassignment Care Compare group NPD
• Nikitasha Aggarwal, DO

  • Family Medicine Physician
  • Centralia, WA
  • NPI 1063904696
  Medicare reassignment Care Compare group NPD
• Jowairiyya Sarfraz Ahmad, M.D.

  • Rheumatology Physician
  • Lacey, WA
  • NPI 1447539408
  Medicare reassignment Care Compare group NPD
• Ayesha Akhter, MD

  • Internal Medicine Physician
  • Vancouver, WA
  • NPI 1134174469
  Medicare reassignment Care Compare group NPD
• Chiante R Amato, D.O

  • Family Medicine Physician
  • Lacey, WA
  • NPI 1245545854
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1178064000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747008000000",
    "number": "1174744304",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 31001-4114",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911104114",
            "telephone_number": "877-747-2455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "525 LILLY RD NE",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "98506",
            "telephone_number": "360-793-7230"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1018 Capitol Way S",
            "address_2": "Suite 300",
            "address_purpose": "LOCATION",
            "city": "Olympia",
            "state": "WA",
            "postal_code": "985011212",
            "country_code": "US",
            "telephone_number": "360-486-6508",
            "fax_number": "360-570-2077",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PROVIDENCE HEALTH & SERVICES WASHINGTON",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-02",
        "last_updated": "2025-05-12",
        "certification_date": "2025-05-12",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "WAYNE",
        "authorized_official_title_or_position": "ASSISTANT SECRETARY OF ENROLLMENTS",
        "authorized_official_telephone_number": "425-358-9786",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207QA0505X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adult Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207QG0300X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Providence Medical Group SouthWest Washington",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Providence Medical Group SouthWest Washington",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Judith Freed Provasoli, L.M.H.C.
• Robert Provasoli, D.C.
• Providence Health & Services - Washington (Providence SoundHomecare and Hospice)
• Providence Health & Services Washington (Providence Community Care Center)
• Providence Health & Services Washington (Providence Medical Group Southwest Washington)
• Providence Health & Services Washington (providence mother joseph care cent)
• Providence Health & Services Washington (Providence St Peter Hospital)
• Providence Health & Services Washington (Providence St. Peter Hospital)
• Providence Health & Services Washington
• Providence Health & Services Washington (Providence St. Peter Hospital)

• Family Medicine Physician in Olympia, WA
• Providers in Olympia, WA by specialty
• Family Medicine Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2025; 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.