NPIMap

Organization Active NPI

Proliance Surgeons, Inc., P.S.

  • Ambulatory Surgical Clinic/Center
  • Lakewood, WA
National Provider Identifier
1194727883
Registry record updated Dec 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
601484763 Issued in WA
Legal business name
PROLIANCE SURGEONS, INC., P.S.
Practice address
7308 Bridgeport Way W Ste 102
Lakewood, WA 98499-8000
Phone
(253) 584-5252
Fax
(253) 582-1617
NPI assigned
Aug 11, 2005
Organization subpart
Yes
Parent organization
PROLIANCE SURGEONS, INC. P.S.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 6, 2023

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

Authorized official

Name
Cori M. Pleasant
Title
Del Cred & Enrollment Manager
Phone
(206) 838-2585

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X 601484763 WA Primary

Addresses

Primary practice location

7308 Bridgeport Way W Ste 102
Lakewood, WA 98499-8000

Mailing address

7308 Bridgeport Way W Ste 102
Lakewood, WA 98499-8000
Phone (253) 584-5252

Other identifiers 3

IdentifierTypeStateIssuer
1043206MedicaidWA
223794OtherWAWA LABOR & INDUSTRIES
612815300OtherOWCP

Other names 2

  • Proliance Puget Sound Surgery Center Doing business as
  • Lakewood Surgery Center (FKA) Other name

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031208000102 WA Part B Supplier - Ambulatory Surgical Center 8527972900 14 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Kirkland, WA
O20171211000207 WA Part B Supplier - Ambulatory Surgical Center 8527972900 Practice locations: Lakewood, WA

Other NPIs on the same Medicare enrollment 14

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

View all 14

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Proliance Surgeons Inc PSCCN 50C0001235
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Part of
Orthopedic Physicians

NPI Registry JSON

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

{
    "created_epoch": "1123718400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701820800000",
    "number": "1194727883",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7308 BRIDGEPORT WAY W STE 102",
            "city": "LAKEWOOD",
            "state": "WA",
            "postal_code": "984998000",
            "telephone_number": "253-584-5252",
            "fax_number": "253-582-1617"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7308 BRIDGEPORT WAY W STE 102",
            "city": "LAKEWOOD",
            "state": "WA",
            "postal_code": "984998000",
            "telephone_number": "253-584-5252",
            "fax_number": "253-582-1617"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROLIANCE SURGEONS, INC., P.S.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PROLIANCE SURGEONS, INC. P.S.",
        "enumeration_date": "2005-08-11",
        "last_updated": "2023-12-06",
        "certification_date": "2023-12-06",
        "status": "A",
        "authorized_official_last_name": "PLEASANT",
        "authorized_official_first_name": "CORI",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "DEL CRED & ENROLLMENT MANAGER",
        "authorized_official_telephone_number": "206-838-2585"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "WA",
            "license": "601484763",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1043206",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WA LABOR & INDUSTRIES",
            "identifier": "223794",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OWCP",
            "identifier": "612815300",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Proliance Puget Sound Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Lakewood Surgery Center (FKA)",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Lakewood, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 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.