NPIMap

Organization Active NPI

Proliance Surgeons, Inc., P.S.

Doing business as Proliance Surgeons Three Rivers Ear, Nose and Throat

  • Otolaryngology Physician
  • Kennewick, WA
National Provider Identifier
1255683959
Registry record updated Aug 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
601484763 Issued in WA
Legal business name
PROLIANCE SURGEONS, INC., P.S.
Doing business as
Proliance Surgeons Three Rivers Ear, Nose and Throat
Practice address
7105 W Hood PL Ste A103
Kennewick, WA 99336-6714
Phone
(509) 735-5551
Fax
(509) 735-5552
NPI assigned
Oct 5, 2012
Last updated
Aug 22, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2022

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

Authorized official

Name
Cori M. Pleasant
Title
MGR Provider Relations/Enrollment
Phone
(206) 838-2585

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X NU
Otolaryngology Physician 207Y00000X 601484763 WA Primary
Audiologist 231H00000X 601484763 WA

Addresses

Primary practice location

7105 W Hood PL Ste A103
Kennewick, WA 99336-6714

Mailing address

7105 W Hood PL Ste A103
Kennewick, WA 99336-6714
Phone (509) 735-5551

Other identifiers 2

IdentifierTypeStateIssuer
300290OtherWAWA LABOR & INDUSTRIES
2024012MedicaidWA

Other names 1

  • Proliance Surgeons Three Rivers Ear, Nose and Throat Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031119000128 WA Part B Supplier - Clinic/Group Practice 8527972900 Receives reassigned benefits from 781 practitioners
This NPI is an additional NPI on the enrollment

National Provider Directory

National Provider Directory
Tax ID family
The Retina Surgery Center46 organizations share this tax ID, including this one

Other organizations with this tax ID 45

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

View all 45

NPI Registry JSON

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

{
    "created_epoch": "1349395200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1661126400000",
    "number": "1255683959",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7105 W HOOD PL STE A103",
            "city": "KENNEWICK",
            "state": "WA",
            "postal_code": "993366714",
            "telephone_number": "509-735-5551",
            "fax_number": "509-735-5552"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7105 W HOOD PL STE A103",
            "city": "KENNEWICK",
            "state": "WA",
            "postal_code": "993366714",
            "telephone_number": "509-735-5551",
            "fax_number": "509-735-5552"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROLIANCE SURGEONS, INC., P.S.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-05",
        "last_updated": "2022-08-22",
        "certification_date": "2022-08-22",
        "status": "A",
        "authorized_official_last_name": "PLEASANT",
        "authorized_official_first_name": "CORI",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "MGR PROVIDER RELATIONS/ENROLLMENT",
        "authorized_official_telephone_number": "206-838-2585"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "WA",
            "license": "601484763",
            "primary": true
        },
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "WA",
            "license": "601484763",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WA LABOR & INDUSTRIES",
            "identifier": "300290",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2024012",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Proliance Surgeons Three Rivers Ear, Nose and Throat",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kennewick, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2022; 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.