NPIMap

Organization Active NPI

Western Washington Medical Group

Doing business as Western Washington Medical Group Dept of Surgery

  • Surgery Physician
  • Everett, WA
National Provider Identifier
1225256720
Registry record updated Dec 28, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
601474013 Issued in WA
Legal business name
WESTERN WASHINGTON MEDICAL GROUP
Doing business as
Western Washington Medical Group Dept of Surgery
Practice address
3216 Norton Ave Ste 202
Everett, WA 98201-4290
Phone
(425) 259-3181
Fax
(425) 258-3179
NPI assigned
Apr 23, 2007
Last updated
Dec 28, 2010By the provider in NPPES
Organization subpart
Yes
Parent organization
WESTERN WASHINGTON MEDICAL GROUPAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 28, 2010

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

Authorized official

Name
Ms. Vicki McGinnis
Title
Privacy Officer
Phone
(425) 740-4148

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 601474013 WA Primary

Addresses

Primary practice location

3216 Norton Ave Ste 202
Everett, WA 98201-4290

Mailing address

3216 Norton Ave Ste 202
Everett, WA 98201-4290
Phone (425) 259-3181

Other identifiers 3

IdentifierTypeStateIssuer
0049980OtherWALABOR & INDUSTRIES
7056997MedicaidWA
CS8495OtherWARAILROAD MEDICARE

Other names 1

  • Western Washington Medical Group Dept of Surgery Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031107000469 WA Part B Supplier - Clinic/Group Practice 7517870314 Receives reassigned benefits from 130 practitioners
32 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Everett, WA; Lynnwood, WA; Marysville, WA; Monroe, WA; Oak Harbor, WA; Snohomish, WA; Anacortes, WA; Arlington, WA…

Other NPIs on the same Medicare enrollment 32

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

View all 32

National Provider Directory

National Provider Directory
Part of
W Wa Med Group Opthalmo

Practitioners & affiliated clinicians

Practitioners 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1177286400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1293494400000",
    "number": "1225256720",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3216 NORTON AVE STE 202",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982014290",
            "telephone_number": "425-259-3181",
            "fax_number": "425-258-3179"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3216 NORTON AVE STE 202",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982014290",
            "telephone_number": "425-259-3181",
            "fax_number": "425-258-3179"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WESTERN WASHINGTON MEDICAL GROUP",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WESTERN WASHINGTON MEDICAL GROUP",
        "enumeration_date": "2007-04-23",
        "last_updated": "2010-12-28",
        "status": "A",
        "authorized_official_last_name": "MCGINNIS",
        "authorized_official_first_name": "VICKI",
        "authorized_official_title_or_position": "PRIVACY OFFICER",
        "authorized_official_telephone_number": "425-740-4148",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "WA",
            "license": "601474013",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LABOR & INDUSTRIES",
            "identifier": "0049980",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7056997",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CS8495",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Western Washington Medical Group Dept of Surgery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Everett, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2010; 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.