Primary Care Clinic for Adults LLC

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

AP30005666 Issued in WA

Legal business name

PRIMARY CARE CLINIC FOR ADULTS LLC

Practice address

20011 Ballinger Way NE Ste 202
Shoreline, WA 98155-1286

Phone

(425) 806-8360

Fax

(425) 250-8566

NPI assigned

Dec 19, 2007

Organization subpart

No

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

Authorized official

Name

Jaclyn R Wilson, MA

Title

Medical Assistant

Phone

(425) 806-8360

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

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 2

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

• Mary Diane White, MSN, ARNP, FNP

  • Nurse Practitioner
  • Shoreline, WA
  • NPI 1821089046
  Medicare reassignment NPD
• Jennifer Amy Fritz-Millard, ARNP, FNP

  • Family Nurse Practitioner
  • Bothell, WA
  • NPI 1992785265
  NPD (past)

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

{
    "created_epoch": "1198022400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1681171200000",
    "number": "1386828846",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20011 BALLINGER WAY NE STE 202",
            "city": "SHORELINE",
            "state": "WA",
            "postal_code": "981551286",
            "telephone_number": "425-806-8360",
            "fax_number": "425-250-8566"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20011 BALLINGER WAY NE STE 202",
            "city": "SHORELINE",
            "state": "WA",
            "postal_code": "981551286",
            "telephone_number": "425-806-8360",
            "fax_number": "425-250-8566"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIMARY CARE CLINIC FOR ADULTS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-19",
        "last_updated": "2023-04-11",
        "certification_date": "2023-04-11",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "JACLYN",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "MEDICAL ASSISTANT",
        "authorized_official_telephone_number": "425-806-8360",
        "authorized_official_credential": "MA"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner",
            "state": "WA",
            "license": "AP30005666",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kaylee Potebnya
• Samantha F Poyta
• Premere Rehab LLC
• Prevail Practices, PLLC
• Megan Price, RPH
• Princeton L. Co, DDS, PLLC
• PT & OT of Washington, LLC
• Puget Sound Cabulance, LLC
• Puget Sound Health Care System
• Puget Sound Kidney Centers

• Nurse Practitioner in Shoreline, WA
• Providers in Shoreline, WA by specialty
• Nurse Practitioner in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 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.