Proliance Surgeons, Inc., P.S.

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

601484763 Issued in WA

Legal business name

PROLIANCE SURGEONS, INC., P.S.

Doing business as

Proliance Puyallup Surgeons

Practice address

1519 3Rd St SE Ste 210
Puyallup, WA 98372-3742

Phone

(253) 840-4994

Fax

(253) 770-1105

NPI assigned

Oct 23, 2014

Last updated

Nov 1, 2022By the provider in NPPES

Organization subpart

No

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 6

Addresses

Other identifiers 3

Other names 1

• Proliance Puyallup Surgeons Doing business as

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

Locations

Practitioners 16

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.

• Jean Michele C. Belista, PA-C

  • Surgical Physician Assistant
  • Puyallup, WA
  • NPI 1669085726
  NPD
• Bailey N. Boltz, PA-C

  • Surgical Physician Assistant
  • Puyallup, WA
  • NPI 1831790591
  NPD
• Yeasel Chae, AUD

  • Audiologist
  • Federal Way, WA
  • NPI 1003343120
  NPD
• Megan Lynn Charboneau, MD

  • Sports Medicine (Physical Medicine & Rehabilitation) Physician
  • Puyallup, WA
  • NPI 1922114701
  NPD
• Elizabeth Joy Hadley, PA-C

  • Physician Assistant
  • Everett, WA
  • NPI 1174175707
  NPD
• Emily Ossian Hall, MPH, PA-C

  • Physician Assistant
  • Puyallup, WA
  • NPI 1801029665
  NPD
• Namou Kim, MD

  • Otolaryngology Physician
  • Seattle, WA
  • NPI 1336125798
  NPD
• Gregory Ryan Lamberton, M.D.

  • Urology Physician
  • Puyallup, WA
  • NPI 1003094889
  NPD
• Justin David Millard, MD

  • Orthopaedic Surgery Physician
  • Puyallup, WA
  • NPI 1255569968
  NPD
• Christopher Neuman Petty, M.D.

  • Surgery Physician
  • Puyallup, WA
  • NPI 1710930896
  NPD
• Christoph Michael Prummer, M.D.

  • Otolaryngology Physician
  • Puyallup, WA
  • NPI 1740660638
  NPD
• Neal H Shonnard, MD

  • Orthopaedic Surgery of the Spine Physician
  • Puyallup, WA
  • NPI 1932135795
  NPD

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

{
    "created_epoch": "1414022400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1667260800000",
    "number": "1255736971",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1519 3RD ST SE STE 210",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983723742",
            "telephone_number": "253-840-4994",
            "fax_number": "253-770-1105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1519 3RD ST SE STE 210",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983723742",
            "telephone_number": "253-840-4994",
            "fax_number": "253-770-1105"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1519 3rd St SE Ste 230",
            "address_purpose": "LOCATION",
            "city": "Puyallup",
            "state": "WA",
            "postal_code": "983723742",
            "country_code": "US",
            "telephone_number": "253-841-9640",
            "fax_number": "253-841-7645",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PROLIANCE SURGEONS, INC., P.S.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-23",
        "last_updated": "2022-11-01",
        "certification_date": "2022-11-01",
        "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": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": "WA",
            "license": "601484763",
            "primary": true
        },
        {
            "code": "2086X0206X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Surgical Oncology",
            "state": "WA",
            "license": "601484763",
            "primary": false
        },
        {
            "code": "208800000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Urology",
            "state": "WA",
            "license": "601484763",
            "primary": false
        },
        {
            "code": "208C00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Colon & Rectal Surgery",
            "state": "WA",
            "license": "601484763",
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WA LABOR & INDUSTRIES",
            "identifier": "338355",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DME",
            "identifier": "0532700054",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2042632",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Proliance Puyallup Surgeons",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jo Winter Proginoskes, MA, LMHCA
• Prohealth Providers LLC (none)
• Proliance Surgeons Inc P S (Proliance Surgery Center at Rainier)
• Proliance Surgeons Inc PS (Proliance Hillside Medical Surgery Center)
• Proliance Surgeons, Inc., P.S. (Puyallup Ambulatory Surgery Center)
• Proliance Surgeons, Inc., P.S. (Proliance Ear Nose Throat and Allergy Associates)
• Proliance Surgeons, Inc., P.S. (ProSports Imaging NW MRI)
• Proliance Surgeons, Inc., P.S. (Proliance ProSports Imaging NW MRI)
• Prompt Care Direct LLC
• Gregory Bryant Proulx, ARNP

• Surgery Physician in Puyallup, WA
• Providers in Puyallup, WA by specialty
• Surgery Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 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.