Active NPI
Franciscan Medical Group
- Neurological Surgery Physician
- Puyallup, WA
National Provider Identifier
1548215544
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neurological Surgery Physician
- Legal business name
- FRANCISCAN MEDICAL GROUP
- Practice address
- 205 15TH Ave SW
Ste D
Puyallup, WA 98371-7873 - Phone
- (253) 426-4420
- Fax
- (253) 426-4383
- NPI assigned
- May 24, 2006
- Organization subpart
- Yes
- Parent organization
- FRANCISCAN MEDICAL GROUP
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Cliff Robertson
- Title
- Chief Medical Officer
- Phone
- (253) 779-6101
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neurological Surgery Physician | 207T00000X | Primary |
Addresses
Primary practice location
205 15TH Ave SW
Ste D
Puyallup, WA 98371-7873
Mailing address
1708 Yakima Ave
Ste 105
Tacoma, WA 98405-5307
Phone (253) 426-4420
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0190124 | Other | WA | STATE L&I |
| 7115728 | Medicaid | WA |
Other names 1
- FMG-Neurosurgery NW - Puyallup
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031111000789 | WA | Part B Supplier - Clinic/Group Practice | 0547173866 |
Receives reassigned benefits from 1,720 practitioners This NPI is an additional NPI on the enrollment |
National Provider Directory
National Provider Directory- Part of
- Enumclaw Medical Center
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1148428800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1203465600000",
"number": "1548215544",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1708 YAKIMA AVE",
"address_2": "STE 105",
"city": "TACOMA",
"state": "WA",
"postal_code": "984055307",
"telephone_number": "253-426-4420",
"fax_number": "253-426-4383"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "205 15TH AVE SW",
"address_2": "STE D",
"city": "PUYALLUP",
"state": "WA",
"postal_code": "983717873",
"telephone_number": "253-426-4420",
"fax_number": "253-426-4383"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "FRANCISCAN MEDICAL GROUP",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "FRANCISCAN MEDICAL GROUP",
"enumeration_date": "2006-05-24",
"last_updated": "2008-02-20",
"status": "A",
"authorized_official_last_name": "ROBERTSON",
"authorized_official_first_name": "CLIFF",
"authorized_official_title_or_position": "CHIEF MEDICAL OFFICER",
"authorized_official_telephone_number": "253-779-6101"
},
"taxonomies": [
{
"code": "207T00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Neurological Surgery",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE L&I",
"identifier": "0190124",
"state": "WA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7115728",
"state": "WA"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "FMG-Neurosurgery NW - Puyallup",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Puyallup, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2008; 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.