NPIMap

Organization Active NPI

Western Washington Medical Group

  • Specialist
  • Bothell, WA
National Provider Identifier
1194045542
Registry record updated Nov 23, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
207RE0101X Issued in WA
Legal business name
WESTERN WASHINGTON MEDICAL GROUP
Practice address
1909 214TH St SE
Suite 211
Bothell, WA 98021-4412
Phone
(425) 420-1655
NPI assigned
Jun 8, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 23, 2011

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

Authorized official

Name
Jerome Tillinger
Title
Ceo
Phone
(425) 259-4041

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X 207RG0100X WA
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X 207RC0000X WA
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X 207RE0101X WA Primary
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X 213E00000X WA
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X 207Y00000X WA
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X 291U00000X WA
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X 207R00000X WA

Addresses

Primary practice location

1909 214TH St SE
Suite 211
Bothell, WA 98021-4412

Mailing address

1728 W Marine View Dr
Suite 110
Everett, WA 98201-2094
Phone (425) 259-4041

National Provider Directory

National Provider Directory
Tax ID family
Western Wa Medical Group21 organizations share this tax ID, including this one

Other organizations with this tax ID 20

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

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1275955200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1322006400000",
    "number": "1194045542",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1728 W MARINE VIEW DR",
            "address_2": "SUITE 110",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982012094",
            "telephone_number": "425-259-4041"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1909 214TH ST SE",
            "address_2": "SUITE 211",
            "city": "BOTHELL",
            "state": "WA",
            "postal_code": "980214412",
            "telephone_number": "425-420-1655"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WESTERN WASHINGTON MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-08",
        "last_updated": "2011-11-23",
        "status": "A",
        "authorized_official_last_name": "TILLINGER",
        "authorized_official_first_name": "JEROME",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "425-259-4041"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "WA",
            "license": "207RG0100X",
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "WA",
            "license": "207RC0000X",
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "WA",
            "license": "207RE0101X",
            "primary": true
        },
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "WA",
            "license": "213E00000X",
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "WA",
            "license": "207Y00000X",
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "WA",
            "license": "291U00000X",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "WA",
            "license": "207R00000X",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bothell, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.