Proliance Surgeons Inc PS

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

601484763 Issued in WA

Legal business name

PROLIANCE SURGEONS INC PS

Doing business as

Proliance Center for Specialty Surgery

Practice address

515 Minor Ave Ste 130
Seattle, WA 98104-2138

Phone

(206) 838-9500

Fax

(206) 682-3511

NPI assigned

May 26, 2006

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

Del Cred & Enrollment Manager

Phone

(206) 838-2585

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 2

• Proliance Center for Specialty Surgery Doing business as
• Minor and James Surgery Center (FKA) Other name

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

Listed as

Proliance Surgeons Inc PSCCN 50C0001070

Medicare certification status

ActiveFrom the Provider of Services file

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

CLIA laboratory certificates

Locations

Practitioners 31

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.

• Mei Weng Allison, MD

  • Internal Medicine Physician
  • Seattle, WA
  • NPI 1437201241
  NPD (past)
• Carl James Brodie III, M.D.

  • Rheumatology Physician
  • Bellevue, WA
  • NPI 1821102443
  NPD (past)
• Carolyn J Burkhart, ARNP

  • Nurse Practitioner
  • Seattle, WA
  • NPI 1275520744
  NPD (past)
• Julie Lyn Carkin, MD

  • Rheumatology Physician
  • Seattle, WA
  • NPI 1083601579
  NPD (past)
• Herbert W. Chen, M.D.

  • Diagnostic Radiology Physician
  • Lynnwood, WA
  • NPI 1720038078
  NPD (past)
• Stacy M Davis, P.T.

  • Physical Therapist
  • Bellevue, WA
  • NPI 1205875945
  NPD (past)
• John H. Ephron, M.D.

  • Diagnostic Radiology Physician
  • Lynnwood, WA
  • NPI 1871543272
  NPD (past)
• Karin P Heusted, ARNP

  • Nurse Practitioner
  • Bothell, WA
  • NPI 1437213485
  NPD (past)
• Smita Jain, M.D.

  • Diagnostic Radiology Physician
  • Lynnwood, WA
  • NPI 1467489229
  NPD (past)
• Katherine C Johnson, MD

  • Obstetrics & Gynecology Physician
  • Seattle, WA
  • NPI 1295707289
  NPD (past)
• Sonja M. Krejci, MD

  • Dermatology Physician
  • Seattle, WA
  • NPI 1588766620
  NPD (past)
• Rose Marie Laporte, ARNP

  • Adult Health Nurse Practitioner
  • Tacoma, WA
  • NPI 1235167420
  NPD (past)

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

{
    "created_epoch": "1148601600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701820800000",
    "number": "1326094491",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "515 MINOR AVE STE 130",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981042138",
            "telephone_number": "206-838-9500",
            "fax_number": "206-682-3511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "515 MINOR AVE STE 130",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981042138",
            "telephone_number": "206-838-9500",
            "fax_number": "206-682-3511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROLIANCE SURGEONS INC PS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-26",
        "last_updated": "2023-12-06",
        "certification_date": "2023-12-06",
        "status": "A",
        "authorized_official_last_name": "PLEASANT",
        "authorized_official_first_name": "CORI",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "DEL CRED & ENROLLMENT MANAGER",
        "authorized_official_telephone_number": "206-838-2585"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "WA",
            "license": "601484763",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2069773",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WA LABOR & INDUSTRIES",
            "identifier": "353337",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Proliance Center for Specialty Surgery",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Minor and James Surgery Center (FKA)",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Project Access Northwest
• Rachel Marie Prokop, RD CD
• Proliance MSSP Aco LLC
• Proliance Surgeons Inc P S (Proliance Surgeons Orthopedic Specialists of Seattle)
• Proliance Surgeons Inc P S (Proliance Orthopaedics and Sports Medicine)
• Proliance Surgeons Inc PS (Minor and James Endoscopy Center)
• Proliance Surgeons Inc., P.S. (Northwest Orthopaedic Clinic)
• Proliance Surgeons Inc., P.S. (Surgical Associates of Edmonds)
• Proliance Surgeons Inc., P.S. (Orthopedic Physician Associates MRI)
• Proliance Surgeons Inc., P.S. (Northwest Surgical Specialists)

• Ambulatory Surgical Clinic/Center in Seattle, WA
• Providers in Seattle, WA by specialty
• Ambulatory Surgical Clinic/Center in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2023; 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.