NPIMap

Organization Active NPI

Privia Medical Group Washington, PLLC

Doing business as Deer Park Urgent Care

  • Durable Medical Equipment & Medical Supplies
  • Deer Park, WA
National Provider Identifier
1225911829
Registry record updated Oct 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
PRIVIA MEDICAL GROUP WASHINGTON, PLLC
Doing business as
Deer Park Urgent Care
Practice address
702 S Park St Ste a
Deer Park, WA 99006-7025
Phone
(509) 262-9000
Fax
(509) 276-3034
NPI assigned
Jul 30, 2025
Last updated
Oct 7, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 7, 2025

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

Authorized official

Name
Edward Fargis
Title
General Counsel
Phone
(571) 366-8850

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X NU Primary

Addresses

Primary practice location

702 S Park St Ste a
Deer Park, WA 99006-7025

Mailing address

55 W Tietan St
Walla Walla, WA 99362-4445

Other names 1

  • DEER PARK URGENT CARE Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20260608000929 WA DME Supplier - Multi-Specialty - Physician 2264320837 Practice locations: Deer Park, WA

Other NPIs with the same Medicare PAC ID 5

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Walla Walla Clinic Surg7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/98594/brand/1/csg/1/fhir/r4

NPI Registry JSON

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

{
    "created_epoch": "1753833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1759795200000",
    "number": "1225911829",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 W TIETAN ST",
            "city": "WALLA WALLA",
            "state": "WA",
            "postal_code": "993624445"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "702 S PARK ST STE A",
            "city": "DEER PARK",
            "state": "WA",
            "postal_code": "990067025",
            "telephone_number": "509-262-9000",
            "fax_number": "509-276-3034"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIVIA MEDICAL GROUP WASHINGTON, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-07-30",
        "last_updated": "2025-10-07",
        "certification_date": "2025-10-07",
        "status": "A",
        "authorized_official_last_name": "FARGIS",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_title_or_position": "GENERAL COUNSEL",
        "authorized_official_telephone_number": "571-366-8850"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DEER PARK URGENT CARE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Deer Park, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2025; 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.