NPIMap

Organization Active NPI

Northwestern Healthcare Management Services LLC

Doing business as University Place Family Care

  • Primary Care Clinic/Center
  • University Place, WA
National Provider Identifier
1457873002
Registry record updated Jul 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
NORTHWESTERN HEALTHCARE MANAGEMENT SERVICES LLC
Doing business as
University Place Family Care
Practice address
4114 Bridgeport Way W
University Place, WA 98466-4315
Phone
(253) 564-4157
Fax
(253) 564-4813
NPI assigned
Jul 14, 2017
Last updated
Jul 28, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 28, 2023

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

Authorized official

Name
Mitra Hanjani, MDNPI 1881897601
Title
Owner
Phone
(253) 564-4157

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X Primary
Internal Medicine Physician 207R00000X

Addresses

Primary practice location

4114 Bridgeport Way W
University Place, WA 98466-4315

Mailing address

4114 Bridgeport Way W
University Place, WA 98466-4315
Phone (253) 564-4157

Other names 1

  • University Place Family Care Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170831003358 WA Part B Supplier - Clinic/Group Practice 2365715026 Receives reassigned benefits from 2 practitioners
Practice locations: University Place, WA

National Provider Directory

National Provider Directory

Locations

4114 Bridgeport Way W
University Place, WA 98466
Phone (253) 564-4157

4114 Bridgeport Way W
Ste 1
University Place, WA 98466

Practitioners & affiliated clinicians

Practitioners 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1499990400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1690502400000",
    "number": "1457873002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4114 BRIDGEPORT WAY W",
            "city": "UNIVERSITY PLACE",
            "state": "WA",
            "postal_code": "984664315",
            "telephone_number": "253-564-4157",
            "fax_number": "253-220-2491"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4114 BRIDGEPORT WAY W",
            "city": "UNIVERSITY PLACE",
            "state": "WA",
            "postal_code": "984664315",
            "telephone_number": "253-564-4157",
            "fax_number": "253-564-4813"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWESTERN HEALTHCARE MANAGEMENT SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-07-14",
        "last_updated": "2023-07-28",
        "certification_date": "2023-07-28",
        "status": "A",
        "authorized_official_last_name": "HANJANI",
        "authorized_official_first_name": "MITRA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "253-564-4157",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "University Place Family Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "University Place Family Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in University Place, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2023; 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.