NPIMap

Organization Active NPI

Washington State University

Doing business as Cougar Health Services

  • Family Medicine Physician
  • Pullman, WA
National Provider Identifier
1285713776
Registry record updated May 25, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
WASHINGTON STATE UNIVERSITY
Doing business as
Cougar Health Services
Practice address
1125 SE Washington Street
Pullman, WA 99164-2302
Phone
(509) 335-3575
Fax
(509) 335-1684
NPI assigned
Nov 3, 2006
Last updated
May 25, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 25, 2021

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

Authorized official

Name
Joel W. SchwartzkopfNPI 1235253717
Title
Executive Director
Phone
(509) 335-3575

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

1125 SE Washington Street
Pullman, WA 99164-2302

Mailing address

1125 SE Washington Street
PO Box 642302
Pullman, WA 99164-2302
Phone (509) 335-3575

Other identifiers 4

IdentifierTypeStateIssuer
7082100MedicaidWA
7901051MedicaidWA
8936100OtherWACRIME VICTIMS
0048200OtherWALABOR & INDUSTRIES

Other names 1

  • Cougar Health Services Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040727000292 WA Part B Supplier - Clinic/Group Practice 2567432743 Receives reassigned benefits from 3 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Pullman, WA; Spokane, WA

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
50D0687453Cougar Health Services1125 SE Washington St, Pullman, WA 99164Provider-performed microscopyApr 4, 2028

National Provider Directory

National Provider Directory
Tax ID family
Washington State Univer6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Locations

1125 SE Washington St
Pullman, WA 99164
Phone (509) 335-3575

Practitioners & affiliated clinicians

Practitioners 24

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.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1162512000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1621900800000",
    "number": "1285713776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1125 SE WASHINGTON STREET",
            "address_2": "PO BOX 642302",
            "city": "PULLMAN",
            "state": "WA",
            "postal_code": "991642302",
            "telephone_number": "509-335-3575",
            "fax_number": "509-335-1684"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1125 SE WASHINGTON STREET",
            "city": "PULLMAN",
            "state": "WA",
            "postal_code": "991642302",
            "telephone_number": "509-335-3575",
            "fax_number": "509-335-1684"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WASHINGTON STATE UNIVERSITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-03",
        "last_updated": "2021-05-25",
        "certification_date": "2021-05-25",
        "status": "A",
        "authorized_official_last_name": "SCHWARTZKOPF",
        "authorized_official_first_name": "JOEL",
        "authorized_official_middle_name": "W.",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "509-335-3575"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7082100",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7901051",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CRIME VICTIMS",
            "identifier": "8936100",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LABOR & INDUSTRIES",
            "identifier": "0048200",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cougar Health Services",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Cougar Health Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pullman, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.