Active NPI
Franciscan Medical Group
Doing business as FMG-DuPont Medical Clinic
- Family Medicine Physician
- Dupont, WA
National Provider Identifier
1356486260
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- OP00002173
- Legal business name
- FRANCISCAN MEDICAL GROUP
- Doing business as
- FMG-DuPont Medical Clinic
- Practice address
- 1175 Center Dr
#130
Dupont, WA 98327-7733 - Phone
- (253) 539-9735
- Fax
- (253) 539-7981
- NPI assigned
- Feb 20, 2007
- Organization subpart
- Yes
- Parent organization
- FRANCISCAN MEDICAL GROUP
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Cliff A. Robertson, MD
- Title
- Chief Medical Officer
- Phone
- (253) 779-6101
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | OP00002173 | WA | Primary |
Addresses
Primary practice location
1175 Center Dr
#130
Dupont, WA 98327-7733
Mailing address
1175 Center Dr
#130
Dupont, WA 98327-7733
Phone (253) 964-5260
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0217715 | Other | WA | STATE L&I |
| 7137136 | Medicaid | WA | |
| 7136674 | Medicaid | WA |
Other names 1
- FMG-DuPont Medical Clinic
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031111000789 | WA | Part B Supplier - Clinic/Group Practice | 0547173866 |
Receives reassigned benefits from 1,720 practitioners This NPI is an additional NPI on the enrollment |
National Provider Directory
National Provider Directory- Part of
- Enumclaw Medical Center
Locations
1717 S J St
#138
Tacoma, WA 98405
Phone (979) 292-5012
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171929600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1213920000000",
"number": "1356486260",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1175 CENTER DR",
"address_2": "#130",
"city": "DUPONT",
"state": "WA",
"postal_code": "983277733",
"telephone_number": "253-964-5260",
"fax_number": "253-964-5266"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1175 CENTER DR",
"address_2": "#130",
"city": "DUPONT",
"state": "WA",
"postal_code": "983277733",
"telephone_number": "253-539-9735",
"fax_number": "253-539-7981"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "FRANCISCAN MEDICAL GROUP",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "FRANCISCAN MEDICAL GROUP",
"enumeration_date": "2007-02-20",
"last_updated": "2008-06-20",
"status": "A",
"authorized_official_last_name": "ROBERTSON",
"authorized_official_first_name": "CLIFF",
"authorized_official_middle_name": "A.",
"authorized_official_title_or_position": "CHIEF MEDICAL OFFICER",
"authorized_official_telephone_number": "253-779-6101",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Family Medicine",
"state": "WA",
"license": "OP00002173",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE L&I",
"identifier": "0217715",
"state": "WA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7137136",
"state": "WA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7136674",
"state": "WA"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "FMG-DuPont Medical Clinic",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Dupont, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2008; 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.