NPIMap

Organization Active NPI

Coast Spine and Sports Medicine PLLC

  • Physical Medicine & Rehabilitation Physician
  • Kirkland, WA
National Provider Identifier
1528876109
Registry record updated Dec 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
Legal business name
COAST SPINE AND SPORTS MEDICINE PLLC
Doing business as
Coast Injury Medicine
Practice address
12220 113TH Ave NE Ste 110
Kirkland, WA 98034-6915
Phone
(253) 648-1853
Fax
(425) 800-9756
NPI assigned
Dec 27, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 27, 2024

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

Authorized official

Name
Sandy Clemens
Title
Access Manager
Phone
(253) 648-1853

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208100000X Primary

Addresses

Primary practice location

12220 113TH Ave NE Ste 110
Kirkland, WA 98034-6915

Mailing address

8012 112TH Street CT E Ste 120
Puyallup, WA 98373-7856
Phone (253) 648-1853

Other names 1

  • Coast Injury Medicine Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Coast Injury Medicine6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Locations

12220 113th Ave NE
Ste 110
Kirkland, WA 98034
Phone (253) 648-1853

NPI Registry JSON

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

{
    "created_epoch": "1735257600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1735257600000",
    "number": "1528876109",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8012 112TH STREET CT E STE 120",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983737856",
            "telephone_number": "253-648-1853",
            "fax_number": "425-800-9756"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12220 113TH AVE NE STE 110",
            "city": "KIRKLAND",
            "state": "WA",
            "postal_code": "980346915",
            "telephone_number": "253-648-1853",
            "fax_number": "425-800-9756"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COAST SPINE AND SPORTS MEDICINE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-12-27",
        "last_updated": "2024-12-27",
        "certification_date": "2024-12-27",
        "status": "A",
        "authorized_official_last_name": "CLEMENS",
        "authorized_official_first_name": "SANDY",
        "authorized_official_title_or_position": "ACCESS MANAGER",
        "authorized_official_telephone_number": "253-648-1853"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Coast Injury Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kirkland, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.