NPIMap

Organization Active NPI

Fern Lane Company, LLC

Doing business as Thrive Direct Health Care

  • Primary Care Clinic/Center
  • La Conner, WA
National Provider Identifier
1497255293
Registry record updated Jan 15, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
FERN LANE COMPANY, LLC
Doing business as
Thrive Direct Health Care
Practice address
708 E Morris St
Suite B
La Conner, WA 98257
Phone
(360) 630-5141
Fax
(866) 302-7491
NPI assigned
Feb 19, 2018
Last updated
Jan 15, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 15, 2020

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

Authorized official

Name
Dr. Brianna Wilson, ARNPNPI 1083047369
Title
Owner
Phone
(360) 941-5519

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
Pain Clinic/Center 261QP3300X

Addresses

Primary practice location

708 E Morris St
Suite B
La Conner, WA 98257

Mailing address

PO Box 2104
La Conner, WA 98257-2104
Phone (360) 630-5141

Other names 1

  • Thrive Direct Health Care Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180907001031 WA Part B Supplier - Clinic/Group Practice 0840540159 Receives reassigned benefits from 3 practitioners
Practice locations: La Conner, WA

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
50D2146797Thrive Direct Health Care708 Morris St Ste B, La Conner, WA 98257Certificate of waiverApr 4, 2028

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 5

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": "1518998400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1579046400000",
    "number": "1497255293",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2104",
            "city": "LA CONNER",
            "state": "WA",
            "postal_code": "982572104",
            "telephone_number": "360-630-5141",
            "fax_number": "866-302-7491"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "708 E MORRIS ST",
            "address_2": "SUITE B",
            "city": "LA CONNER",
            "state": "WA",
            "postal_code": "98257",
            "telephone_number": "360-630-5141",
            "fax_number": "866-302-7491"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FERN LANE COMPANY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-02-19",
        "last_updated": "2020-01-15",
        "certification_date": "2020-01-15",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "BRIANNA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "360-941-5519",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "ARNP"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QP3300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Pain",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Thrive Direct Health Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in La Conner, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2020; 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.