NPIMap

Organization Active NPI

Surgical Associates Northwest, P.C.

  • Urology Physician
  • Federal Way, WA
National Provider Identifier
1427128198
Registry record updated Jul 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
Legal business name
SURGICAL ASSOCIATES NORTHWEST, P.C.
Practice address
34612 6TH Ave S Ste 110
Federal Way, WA 98003-8723
Phone
(253) 661-2594
Fax
(253) 661-2694
NPI assigned
Nov 9, 2006
Last updated
Jul 12, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
SURGICAL ASSOCIATES NORTHWEST, P.C.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 12, 2024

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

Authorized official

Name
Pam Stanfill
Title
Office Manager
Phone
(253) 661-2591

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Allergy & Immunology Physician 207K00000X NU
Otolaryngology/Facial Plastic Surgery Physician 207YX0905X NU
Urology Physician 208800000X NU Primary

Addresses

Primary practice location

34612 6TH Ave S Ste 110
Federal Way, WA 98003-8723

Mailing address

34612 6TH Ave S
Suite 210
Federal Way, WA 98003-8723
Phone (253) 661-2594

Other practice location 1

34612 6th Ave S
Suite 110
Federal Way, WA 98003-8723
Phone (253) 661-2594

Other identifiers 1

IdentifierTypeStateIssuer
7125081MedicaidWA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040406000126 WA Part B Supplier - Clinic/Group Practice 3971596024 Receives reassigned benefits from 18 practitioners
Practice locations: Auburn, WA; Federal Way, WA

Other NPIs with the same Medicare PAC ID 1

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

National Provider Directory

National Provider Directory
Tax ID family
NW Urology Specialists5 organizations share this tax ID, including this one
Part of
NW Urology Specialists

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

202 N Division St
Ste 100
Auburn, WA 98001
Phone (253) 223-0515

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 20

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 20

NPI Registry JSON

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

{
    "created_epoch": "1163030400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1720742400000",
    "number": "1427128198",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "34612 6TH AVE S",
            "address_2": "SUITE 210",
            "city": "FEDERAL WAY",
            "state": "WA",
            "postal_code": "980038723",
            "telephone_number": "253-661-2594",
            "fax_number": "253-661-2694"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "34612 6TH AVE S STE 110",
            "city": "FEDERAL WAY",
            "state": "WA",
            "postal_code": "980038723",
            "telephone_number": "253-661-2594",
            "fax_number": "253-661-2694"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "34612 6th Ave S",
            "address_2": "SUITE 110",
            "address_purpose": "LOCATION",
            "city": "Federal Way",
            "state": "WA",
            "postal_code": "980038723",
            "country_code": "US",
            "telephone_number": "253-661-2594",
            "fax_number": "253-661-2694",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SURGICAL ASSOCIATES NORTHWEST, P.C.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SURGICAL ASSOCIATES NORTHWEST, P.C.",
        "enumeration_date": "2006-11-09",
        "last_updated": "2024-07-12",
        "certification_date": "2024-07-12",
        "status": "A",
        "authorized_official_last_name": "STANFILL",
        "authorized_official_first_name": "PAM",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "253-661-2591"
    },
    "taxonomies": [
        {
            "code": "207K00000X",
            "taxonomy_group": "",
            "desc": "Allergy & Immunology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207YX0905X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Otolaryngology/Facial Plastic Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7125081",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 Jul 12, 2024; 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.