NPIMap

Organization Active NPI

Professional Recreation Organization, Inc.

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Bellevue, WA
National Provider Identifier
1245726538
Registry record updated Jul 10, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianTaxonomy code 208G00000X
License
600541508 Issued in WA
Legal business name
PROFESSIONAL RECREATION ORGANIZATION, INC.
Doing business as
PRO Sports Club
Practice address
4455 148TH Ave NE
Bellevue, WA 98007-3120
Phone
(425) 869-4746
Fax
(425) 869-5285
NPI assigned
Jul 10, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2018

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

Authorized official

Name
Melissa Burgess
Title
Medical Billing & Credentialing
Phone
(425) 895-6575

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208G00000X 600541508 WA Primary

Addresses

Primary practice location

4455 148TH Ave NE
Bellevue, WA 98007-3120

Mailing address

4455 148TH Ave NE
Bellevue, WA 98007-3120
Phone (425) 869-4746

Other names 1

  • PRO Sports Club Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Pro Sports Club14 organizations share this tax ID, including this one

Other organizations with this tax ID 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1531180800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1531180800000",
    "number": "1245726538",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4455 148TH AVE NE",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980073120",
            "telephone_number": "425-869-4746",
            "fax_number": "425-869-5285"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4455 148TH AVE NE",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980073120",
            "telephone_number": "425-869-4746",
            "fax_number": "425-869-5285"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL RECREATION ORGANIZATION, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-07-10",
        "last_updated": "2018-07-10",
        "status": "A",
        "authorized_official_last_name": "BURGESS",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_title_or_position": "MEDICAL BILLING & CREDENTIALING",
        "authorized_official_telephone_number": "425-895-6575"
    },
    "taxonomies": [
        {
            "code": "208G00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "WA",
            "license": "600541508",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PRO Sports Club",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "PRO Sports Club",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bellevue, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.