NPIMap

Organization Active NPI

Multicare Health System

Doing business as Pediatrics Northwest by Mary Bridge Children's

  • Pediatrics Physician
  • Federal Way, WA
National Provider Identifier
1407409741
Registry record updated Oct 22, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
MULTICARE HEALTH SYSTEM
Doing business as
Pediatrics Northwest by Mary Bridge Children's
Practice address
505 S 336TH St # 210
Federal Way, WA 98003-5947
Phone
(253) 383-5777
Fax
(253) 383-5320
NPI assigned
Jul 16, 2019
Last updated
Oct 22, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 22, 2019

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

Authorized official

Name
Kelly E Williams
Title
Manager, Provider Data & Enrollment
Phone
(253) 459-8009

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X NU Primary
Pediatric Allergy/Immunology Physician 2080P0201X NU
Pediatric Hematology & Oncology Physician 2080P0207X NU
Pediatric Pulmonology Physician 2080P0214X NU
Pediatric Nurse Practitioner 363LP0200X NU
Pediatric Sleep Medicine Physician 2080S0012X NU

Addresses

Primary practice location

505 S 336TH St # 210
Federal Way, WA 98003-5947

Mailing address

315 Martin Luther King Jr Way
Tacoma, WA 98405-4234

Other names 1

  • Pediatrics Northwest by Mary Bridge Children's Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031105000760 WA Part B Supplier - Clinic/Group Practice 7719899897 Receives reassigned benefits from 4,909 practitioners
This NPI is an additional NPI on the enrollment

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 115

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 115

NPI Registry JSON

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

{
    "created_epoch": "1563235200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1571702400000",
    "number": "1407409741",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "315 MARTIN LUTHER KING JR WAY",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984054234"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "505 S 336TH ST # 210",
            "city": "FEDERAL WAY",
            "state": "WA",
            "postal_code": "980035947",
            "telephone_number": "253-383-5777",
            "fax_number": "253-383-5320"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MULTICARE HEALTH SYSTEM",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-16",
        "last_updated": "2019-10-22",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "MANAGER, PROVIDER DATA & ENROLLMENT",
        "authorized_official_telephone_number": "253-459-8009"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "2080P0201X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Allergy/Immunology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2080P0207X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Hematology-Oncology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2080P0214X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Pulmonology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2080S0012X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Sleep Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pediatrics Northwest by Mary Bridge Children's",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Pediatrics Northwest by Mary Bridge Children's",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Federal Way, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2019; 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.