NPIMap

Organization Active NPI

Pain Care Physicians PLLC

  • Interventional Pain Medicine Physician
  • Olympia, WA
National Provider Identifier
1356960769
Registry record updated Jul 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X
Legal business name
PAIN CARE PHYSICIANS PLLC
Practice address
155 Lilly Rd NE Ste a
Olympia, WA 98506-5028
Phone
(206) 538-6300
Fax
(206) 538-6301
NPI assigned
Apr 15, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2025

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

Authorized official

Name
Kevin Brian Moon
Title
Director of Revenue and Finance
Phone
(206) 538-6300

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208VP0000X
Interventional Pain Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208VP0014X Primary

Addresses

Primary practice location

155 Lilly Rd NE Ste a
Olympia, WA 98506-5028

Mailing address

801 SW 16TH St Ste 121
Renton, WA 98057-2628
Phone (206) 538-6300

Other identifiers 1

IdentifierTypeStateIssuer
1144779232OtherBILLING GROUP NPI

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200730001004 WA DME Supplier - Physician - Interventional Pain Management 9537448931 Practice locations: Olympia, WA

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Pain Care Physicians PLLC6 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.

NPI Registry JSON

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

{
    "created_epoch": "1586908800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1753056000000",
    "number": "1356960769",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 SW 16TH ST STE 121",
            "city": "RENTON",
            "state": "WA",
            "postal_code": "980572628",
            "telephone_number": "206-538-6300",
            "fax_number": "206-538-6301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "155 LILLY RD NE STE A",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985065028",
            "telephone_number": "206-538-6300",
            "fax_number": "206-538-6301"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAIN CARE PHYSICIANS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-04-15",
        "last_updated": "2025-07-21",
        "certification_date": "2025-07-21",
        "status": "A",
        "authorized_official_last_name": "MOON",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "BRIAN",
        "authorized_official_title_or_position": "DIRECTOR OF REVENUE AND FINANCE",
        "authorized_official_telephone_number": "206-538-6300"
    },
    "taxonomies": [
        {
            "code": "208VP0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BILLING GROUP NPI",
            "identifier": "1144779232",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Olympia, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2025; 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.