NPIMap

Organization Active NPI

Pioneer Family Practice, PLLC

  • Family Medicine Physician
  • Lacey, WA
National Provider Identifier
1205965365
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
PIONEER FAMILY PRACTICE, PLLC
Practice address
5130 Corporate Center CT SE
Lacey, WA 98503-5957
Phone
(360) 413-8600
Fax
(360) 413-8822
NPI assigned
Mar 5, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Authorized official

Name
Diane M Taylor
Title
Business Manager
Phone
(360) 413-8617

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

5130 Corporate Center CT SE
Lacey, WA 98503-5957

Mailing address

5130 Corporate Center CT SE
Lacey, WA 98503-5957
Phone (360) 413-8600

Other identifiers 4

IdentifierTypeStateIssuer
147741OtherWALABOR AND INUDUSTRY
7105869MedicaidWA
02OtherWACORPORATE
1205965365OtherWANPI

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040802000358 WA Part B Supplier - Clinic/Group Practice 5890766232 Receives reassigned benefits from 7 practitioners
Practice locations: Olympia, WA; Lacey, WA

National Provider Directory

National Provider Directory

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/GCCGAA

Practitioners & affiliated clinicians

Practitioners 7

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": "1173052800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1205965365",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5130 CORPORATE CENTER CT SE",
            "city": "LACEY",
            "state": "WA",
            "postal_code": "985035957",
            "telephone_number": "360-413-8600",
            "fax_number": "360-413-8822"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5130 CORPORATE CENTER CT SE",
            "city": "LACEY",
            "state": "WA",
            "postal_code": "985035957",
            "telephone_number": "360-413-8600",
            "fax_number": "360-413-8822"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PIONEER FAMILY PRACTICE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-05",
        "last_updated": "2023-03-07",
        "status": "A",
        "authorized_official_last_name": "TAYLOR",
        "authorized_official_first_name": "DIANE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "360-413-8617"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LABOR AND INUDUSTRY",
            "identifier": "147741",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7105869",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CORPORATE",
            "identifier": "02",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1205965365",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lacey, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.