PB Primary Care Clinic LLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

PB PRIMARY CARE CLINIC LLC

Practice address

34617 11TH PL S Ste 204
Federal Way, WA 98003-8706

Phone

(253) 874-8445

Fax

(253) 874-2085

NPI assigned

Apr 26, 2010

Organization subpart

No

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

Authorized official

Name

Philip BuenvenidaNPI 1386660579

Title

Owner

Phone

(253) 874-8445

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 2

• PB PRIMARY CARE CLINIC LLC Doing business as
• Philip N. Buenvenida, MD Former legal business name

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Philip Narciso Buenvenida, MD

  • Family Medicine Physician
  • Federal Way, WA
  • NPI 1386660579
  Medicare reassignment Care Compare group Authorized official
• Ma Isabel Abuhon Obligacion, NP

  • Family Nurse Practitioner
  • Maple Valley, WA
  • NPI 1760017115
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1272240000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714521600000",
    "number": "1346567666",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "34617 11TH PL S STE 204",
            "city": "FEDERAL WAY",
            "state": "WA",
            "postal_code": "980038706",
            "telephone_number": "253-874-8445",
            "fax_number": "253-874-2085"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "34617 11TH PL S STE 204",
            "city": "FEDERAL WAY",
            "state": "WA",
            "postal_code": "980038706",
            "telephone_number": "253-874-8445",
            "fax_number": "253-874-2085"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "34616 11th Pl S Ste 6",
            "address_purpose": "LOCATION",
            "city": "Federal Way",
            "state": "WA",
            "postal_code": "980038705",
            "country_code": "US",
            "telephone_number": "253-874-8445",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PB PRIMARY CARE CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-04-26",
        "last_updated": "2024-05-01",
        "certification_date": "2024-05-01",
        "status": "A",
        "authorized_official_last_name": "BUENVENIDA",
        "authorized_official_first_name": "PHILIP",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "253-874-8445"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1050640",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "000109367",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PB PRIMARY CARE CLINIC LLC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Philip N. Buenvenida, MD",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Philip N. Buenvenida, MD",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Elizabeth S Paul
• Henry E Paul
• Jill Elisa Paulson, COTA/L
• Tatyana Zonikovna Pavlyuk
• Annalyse L Payne
• Melissa Lynn Pederson, MSW
• Pediatric Clinic
• Pediatric Specialty Practices, PLLC
• Melanie Pellizzon, LMFTA
• People of Color Against AIDS Network

• Primary Care Clinic/Center in Federal Way, WA
• Providers in Federal Way, WA by specialty
• Primary Care Clinic/Center in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2024; 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.