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Puget Sound Gastroenterology, PLLC

Organization Active NPI Ambulatory Surgical Clinic/Center · Kirkland, WA

NPI 1447212337 · NPPES record last updated May 16, 2025

Key facts

NPI
1447212337
Entity type
Organization (NPI type 2)
Primary specialty
Ambulatory Surgical Clinic/Center 261QA1903X
Legal business name
PUGET SOUND GASTROENTEROLOGY, PLLC
Practice address
11800 NE 128TH St
Suite 100
Kirkland, WA 98034-7208
Phone
(425) 899-4500
Fax
(425) 899-4510
NPI assigned
Apr 5, 2006
Organization subpart
No

Authorized official

Name
Alan Oliver, CEO
Title
Ceo
Phone
(786) 530-3820

Other NPIs with the same Medicare PAC ID 2

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

Practitioners 59

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

View all 59

Medicare Care Compare: Ambulatory surgical center

Listed as
Puget Sound Gastroetnerology at Kirklandevergreen Endo Ctr CCN 50C0001095
Medicare certification status
Active (Provider of Services file)

Source: Medicare Care Compare.

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
50D0630298Evergreen Endoscopy Center - Kirkland
11800 NE 128TH St Ste 100, Kirkland, WA 98034		Certificate of waiverApr 4, 2028

Medicare participation

Medicare fee-for-service enrollment
Enrolled in WA

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20190820000174 WA Part B Supplier - Ambulatory Surgical Center 1759278252 Practice locations: Kirkland, WA

National Provider Directory

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X Yes

Addresses

Primary practice location

11800 NE 128TH St
Suite 100
Kirkland, WA 98034-7208

Mailing address

PO Box 34888
Seattle, WA 98124-1888
Phone (425) 977-4620

Other identifiers

IdentifierTypeStateIssuer
0155305OtherWALABOR AND INDUSTRIES
1044235MedicaidWA

Other names

  • Evergreen Endoscopy Center Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on May 16, 2025.

{
    "created_epoch": "1144195200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747353600000",
    "number": "1447212337",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 34888",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981241888",
            "telephone_number": "425-977-4620",
            "fax_number": "425-745-9836"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11800 NE 128TH ST",
            "address_2": "SUITE 100",
            "city": "KIRKLAND",
            "state": "WA",
            "postal_code": "980347208",
            "telephone_number": "425-899-4500",
            "fax_number": "425-899-4510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PUGET SOUND GASTROENTEROLOGY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-05",
        "last_updated": "2025-05-16",
        "certification_date": "2025-05-16",
        "status": "A",
        "authorized_official_last_name": "OLIVER",
        "authorized_official_first_name": "ALAN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "786-530-3820",
        "authorized_official_credential": "CEO"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LABOR AND INDUSTRIES",
            "identifier": "0155305",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1044235",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Evergreen Endoscopy Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Evergreen Endoscopy Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kirkland, WA

All providers in Kirkland, WA · Ambulatory Surgical Clinic/Center in Washington

Sources for this page

Verify at the official NPI Registry.