NPIMap

Organization Active NPI

Western Washington Medical Group, Inc PS

Doing business as Western Wa Medical Group Dept of Orthopedics

  • Orthopaedic Surgery Physician
  • Everett, WA
National Provider Identifier
1376761775
Registry record updated Feb 23, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License
601474013 Issued in WA
Legal business name
WESTERN WASHINGTON MEDICAL GROUP, INC PS
Doing business as
Western Wa Medical Group Dept of Orthopedics
Practice address
3726 Broadway
Suite 201
Everett, WA 98201-3788
Phone
(425) 317-9119
Fax
(425) 317-9118
NPI assigned
Apr 23, 2007
Last updated
Feb 23, 2016By the provider in NPPES
Organization subpart
Yes
Parent organization
WESTERN WASHINGTON MEDICAL GROUPAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 23, 2016

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

Authorized official

Name
Ms. Vicki M McGinnis
Title
PM System Administrator
Phone
(425) 740-4148

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X 601474013 WA Primary

Addresses

Primary practice location

3726 Broadway
Suite 201
Everett, WA 98201-3788

Mailing address

3726 Broadway
Suite 201
Everett, WA 98201-3787
Phone (425) 317-9119

Other identifiers 4

IdentifierTypeStateIssuer
0728350005OtherNPI
7067648MedicaidWA
0036257OtherWALABOR & INDUSTRY
CQ2138OtherWARAILROAD MEDICARE

Other names 1

  • Western Wa Medical Group Dept of Orthopedics Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031107000469 WA Part B Supplier - Clinic/Group Practice 7517870314 Receives reassigned benefits from 130 practitioners
32 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Everett, WA; Lynnwood, WA; Marysville, WA; Monroe, WA; Oak Harbor, WA; Snohomish, WA; Anacortes, WA; Arlington, WA…
O20100930007993 WA DME Supplier - Physician - General Surgery 7517870314 Practice locations: Everett, WA

Other NPIs with the same Medicare PAC ID 6

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

Other NPIs on the same Medicare enrollment 32

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 32

National Provider Directory

National Provider Directory
Part of
Western Wa Medical Group

Practitioners & affiliated clinicians

Practitioners 13

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.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1177286400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1456185600000",
    "number": "1376761775",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3726 BROADWAY",
            "address_2": "SUITE 201",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982013787",
            "telephone_number": "425-317-9119",
            "fax_number": "425-317-9118"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3726 BROADWAY",
            "address_2": "SUITE 201",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982013788",
            "telephone_number": "425-317-9119",
            "fax_number": "425-317-9118"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WESTERN WASHINGTON MEDICAL GROUP, INC PS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WESTERN WASHINGTON MEDICAL GROUP",
        "enumeration_date": "2007-04-23",
        "last_updated": "2016-02-23",
        "status": "A",
        "authorized_official_last_name": "MCGINNIS",
        "authorized_official_first_name": "VICKI",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PM SYSTEM ADMINISTRATOR",
        "authorized_official_telephone_number": "425-740-4148",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "WA",
            "license": "601474013",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "0728350005",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7067648",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LABOR & INDUSTRY",
            "identifier": "0036257",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CQ2138",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Western Wa Medical Group Dept of Orthopedics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Everett, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2016; 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.