NPIMap

Organization Active NPI

South Puget Sound Neurology, PLLC

  • Neurology Physician
  • Tacoma, WA
National Provider Identifier
1194052357
Registry record updated Apr 19, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
Legal business name
SOUTH PUGET SOUND NEUROLOGY, PLLC
Practice address
5006 Center Street
Suite U
Tacoma, WA 98409-2314
Phone
(253) 284-4488
Fax
(253) 272-4771
NPI assigned
Nov 9, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 19, 2023

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

Authorized official

Name
Patrick J Hogan III, DO
Title
President/Physician
Phone
(253) 284-4488

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084N0400X OP00000793 WA
Neurology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084N0400X Primary
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X

Addresses

Primary practice location

5006 Center Street
Suite U
Tacoma, WA 98409-2314

Mailing address

5006 Center Street
Suite U
Tacoma, WA 98409-2314
Phone (253) 284-4488

Other identifiers 1

IdentifierTypeStateIssuer
G8801180MedicaidWA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100316001018 WA Part B Supplier - Clinic/Group Practice 4486789427 Receives reassigned benefits from 7 practitioners
Practice locations: Tacoma, WA

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
50D2064549South Puget Sound Neurology5006 Center St Ste U, Tacoma, WA 98409Certificate of waiverApr 4, 2028

National Provider Directory

National Provider Directory

Locations

5006 Center St
Ste U
Tacoma, WA 98409
Phone (253) 284-4488

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1257724800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1681862400000",
    "number": "1194052357",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5006 CENTER STREET",
            "address_2": "SUITE U",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984092314",
            "telephone_number": "253-284-4488",
            "fax_number": "253-272-4771"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5006 CENTER STREET",
            "address_2": "SUITE U",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984092314",
            "telephone_number": "253-284-4488",
            "fax_number": "253-272-4771"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH PUGET SOUND NEUROLOGY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-11-09",
        "last_updated": "2023-04-19",
        "certification_date": "2023-04-19",
        "status": "A",
        "authorized_official_last_name": "HOGAN III",
        "authorized_official_first_name": "PATRICK",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT/PHYSICIAN",
        "authorized_official_telephone_number": "253-284-4488",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "WA",
            "license": "OP00000793",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "G8801180",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tacoma, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2023; 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.