NPIMap

Organization Active NPI

University Place Pediatric Clinic P S

  • Pediatrics Physician
  • Fircrest, WA
National Provider Identifier
1497922421
Registry record updated Jul 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
UNIVERSITY PLACE PEDIATRIC CLINIC P S
Practice address
1033 Regents Blvd Ste 102
Fircrest, WA 98466-6089
Phone
(253) 564-1115
Fax
(253) 565-4552
NPI assigned
May 8, 2008
Last updated
Jul 22, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 22, 2022

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

Authorized official

Name
Pamela Wiles
Title
Accounts Manager
Phone
(253) 564-1115

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X Primary

Addresses

Primary practice location

1033 Regents Blvd Ste 102
Fircrest, WA 98466-6089

Mailing address

1033 Regents Blvd Ste 102
Fircrest, WA 98466-6089
Phone (253) 564-1115

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210422000391 WA Part B Supplier - Mass Immunization (Roster Biller Only) 9234109257 Practice locations: Fircrest, 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
50D0636426University Place Pediatric Clinic1033 Regents Blvd Suite 102, Tacoma, WA 98466Certificate of waiverApr 4, 2028

National Provider Directory

National Provider Directory

Locations

1033 Regents Blvd
Ste 102
Fircrest, WA 98466
Phone (253) 564-1115

Practitioners & affiliated clinicians

Practitioners 12

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": "1210204800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658448000000",
    "number": "1497922421",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1033 REGENTS BLVD STE 102",
            "city": "FIRCREST",
            "state": "WA",
            "postal_code": "984666089",
            "telephone_number": "253-564-1115",
            "fax_number": "253-565-4552"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1033 REGENTS BLVD STE 102",
            "city": "FIRCREST",
            "state": "WA",
            "postal_code": "984666089",
            "telephone_number": "253-564-1115",
            "fax_number": "253-565-4552"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNIVERSITY PLACE PEDIATRIC CLINIC P S",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-08",
        "last_updated": "2022-07-22",
        "certification_date": "2022-07-22",
        "status": "A",
        "authorized_official_last_name": "WILES",
        "authorized_official_first_name": "PAMELA",
        "authorized_official_title_or_position": "ACCOUNTS MANAGER",
        "authorized_official_telephone_number": "253-564-1115"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fircrest, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2022; 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.