NPIMap

Organization Active NPI

Evergreen Eye Center, PLLC

Doing business as Eye Associates Northwest Surgery Center

  • Ambulatory Surgical Clinic/Center
  • Seattle, WA
National Provider Identifier
1184689408
Registry record updated May 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
Legal business name
EVERGREEN EYE CENTER, PLLC
Doing business as
Eye Associates Northwest Surgery Center
Practice address
1455 NW Leary Way
Suite 300
Seattle, WA 98107-5136
Phone
(206) 342-6041
Fax
(206) 781-8693
NPI assigned
Apr 19, 2006
Last updated
May 30, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
EYE ASSOCIATES NORTHWEST, PLLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 30, 2024

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

Authorized official

Name
Gary Whakuk Chung, MDNPI 1275642779
Title
Authorized Official/Physician
Phone
(206) 212-2100

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 NU Primary
Durable Medical Equipment & Medical Supplies 332B00000X NU

Addresses

Primary practice location

1455 NW Leary Way
Suite 300
Seattle, WA 98107-5136

Mailing address

1101 Madison St
Suite 600
Seattle, WA 98104-1306
Phone (206) 215-2004

Other identifiers 2

IdentifierTypeStateIssuer
7094410MedicaidWA
LABOR & INDUSTRIESOtherWA0014585

Other names 1

  • Eye Associates Northwest Surgery Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240821004659 WA Part B Supplier - Ambulatory Surgical Center 3173410057 Practice locations: Seattle, WA

Other NPIs with the same Medicare PAC ID 4

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

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Eye Associates Northwest Surgery CenterCCN 50C0001014
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
Evergreen Eye Center in11 organizations share this tax ID, including this one
Part of
Eye Associates Northwest

Other organizations with this tax ID 10

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

Locations

33915 1st Way S
Ste 120A
Federal Way, WA 98003
Phone (206) 260-2504

8301 161st Ave NE
#307
Redmond, WA 98052
Phone (206) 885-3574

1455 NW Leary Way
Ste 300
Seattle, WA 98107
Phone (206) 784-3350

5300 17th Ave NW
Seattle, WA 98107
Phone (206) 783-3929

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 41

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 41

NPI Registry JSON

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

{
    "created_epoch": "1145404800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1717027200000",
    "number": "1184689408",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1101 MADISON ST",
            "address_2": "SUITE 600",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981041306",
            "telephone_number": "206-215-2004",
            "fax_number": "206-215-2055"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1455 NW LEARY WAY",
            "address_2": "SUITE 300",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981075136",
            "telephone_number": "206-342-6041",
            "fax_number": "206-781-8693"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN EYE CENTER, PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EYE ASSOCIATES NORTHWEST, PLLC",
        "enumeration_date": "2006-04-19",
        "last_updated": "2024-05-30",
        "certification_date": "2024-05-30",
        "status": "A",
        "authorized_official_last_name": "CHUNG",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "WHAKUK",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL/PHYSICIAN",
        "authorized_official_telephone_number": "206-212-2100",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7094410",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "0014585",
            "identifier": "LABOR & INDUSTRIES",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eye Associates Northwest Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Eye Associates Northwest Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Seattle, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 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.