NPIMap

Individual provider Active NPI

Jared Bruce, DO

  • General Practice Physician
  • Lacey, WA
National Provider Identifier
1295272433
Registry record updated Sep 28, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
OP61168034 Issued in WA
Practice address
1400 Brittany LN NE Apt A106
Lacey, WA 98516-5779
Phone
(760) 484-6469
NPI assigned
Jan 26, 2017
Last updated
Sep 28, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X NU
General Practice Physician 208D00000X OP61168034 WA Primary

Addresses

Primary practice location

1400 Brittany LN NE Apt A106
Lacey, WA 98516-5779

Mailing address

1400 Brittany LN NE Apt A106
Lacey, WA 98516-5779
Phone (760) 484-6469

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211220000320 WA Practitioner - General Practice 0648661058 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
General Practice
Education
Arizona College of Osteopathic Medicine Mid Western University, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Washington Pac Services PCGroup PAC ID 4082986070, 43 clinicians
Wa Pacs 2 PCGroup PAC ID 6901156538, 26 clinicians

Practice addresses (Care Compare)

3309 45TH St CT
Gig Harbor, WA 98335-8222
Phone (253) 858-8688

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
OP61168034WAMDGeneral Practice Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Doctor to You CurrentSince Oct 5, 2021 Accepting new patients
CS Pacs 3 Northwest, LLC CurrentSince Sep 28, 2024 Accepting new patients
Gig Harbor SNF Operations LLC Past Accepting new patients
Tacoma SNF Operations LLC Past Accepting new patients
Lacey SNF Operations LLC Past Accepting new patients
Eliseo Past Accepting new patients
Woodard SNF Operations LLC Past Accepting new patients

Locations

21008 76th Ave W
Edmonds, WA 98026
Phone (425) 778-0107

135 S 336th St
Federal Way, WA 98003
Phone (253) 835-7433

3309 45th Street Ct
Gig Harbor, WA 98335
Phone (253) 457-0516

920 12th Ave SE
Puyallup, WA 98372
Phone (253) 841-3422

3600 E Hartson Ave
Spokane, WA 99202
Phone (509) 468-7000

14820 E 4th Ave
Spokane Valley, WA 99216
Phone (509) 922-1644

Organizations & group practices 9

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1485388800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632787200000",
    "number": "1295272433",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 BRITTANY LN NE APT A106",
            "city": "LACEY",
            "state": "WA",
            "postal_code": "985165779",
            "telephone_number": "760-484-6469"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 BRITTANY LN NE APT A106",
            "city": "LACEY",
            "state": "WA",
            "postal_code": "985165779",
            "telephone_number": "760-484-6469"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRUCE",
        "first_name": "JARED",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-01-26",
        "last_updated": "2021-09-28",
        "certification_date": "2021-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "WA",
            "license": "OP61168034",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lacey, WA

Sources for this page

Verify at the official NPI Registry.