South Sound Medical Group, PLLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

MD60162757 Issued in WA

Legal business name

SOUTH SOUND MEDICAL GROUP, PLLC

Practice address

10116 Coachman LN SE
Olympia, WA 98501-9731

Phone

(360) 556-8465

NPI assigned

Jul 17, 2015

Organization subpart

No

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

Authorized official

Name

Jessica Van Fleet-Green, M.D.

Title

Owner/MD

Phone

(360) 556-8465

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1437091200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1442966400000",
    "number": "1285018432",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10116 COACHMAN LN SE",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985019731",
            "telephone_number": "360-556-8465"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10116 COACHMAN LN SE",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985019731",
            "telephone_number": "360-556-8465"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH SOUND MEDICAL GROUP, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-17",
        "last_updated": "2015-09-23",
        "status": "A",
        "authorized_official_last_name": "VAN FLEET-GREEN",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_title_or_position": "OWNER/MD",
        "authorized_official_telephone_number": "360-556-8465",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "MD60162757",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1679736318",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1679736318",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• South Sound Family Dentistry
• South Sound Family Dentistry, PLLC
• South Sound Health & Fitness
• South Sound Inpatient Physicians PLLC
• South Sound Internal Medicine PLLC
• South Sound Neuropsychology Inc.
• South Sound Oral Surgery PLLC
• South Sound Pediatrics PLLC
• South Sound Pediatrics PLLC
• South Sound Physical & Hand Therapy PLLC

• Family Medicine Physician in Olympia, WA
• Providers in Olympia, WA by specialty
• Family Medicine Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2015; 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.