Snake River Adult Medicine LLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

604282863 Issued in WA

Legal business name

SNAKE RIVER ADULT MEDICINE LLC

Practice address

1625 5TH St
Clarkston, WA 99403-3001

Phone

(509) 295-8398

Fax

(509) 295-8416

NPI assigned

Jun 1, 2018

Organization subpart

No

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

Authorized official

Name

Brian Francis Ciezki, ACNPNPI 1205221041

Title

Owner/Operator

Phone

(509) 295-8398

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

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

CLIA laboratory certificates

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Brian Francis Ciezki, ACNP

  • Adult Health Nurse Practitioner
  • Clarkston, WA
  • NPI 1205221041
  Medicare reassignment Authorized official
• Melody Jean Acey, LMP LICENSED MASSAGE

  • Massage Therapist
  • Clarkston, WA
  • NPI 1538226311
  NPD (past)
• David B Martin, M.D.

  • Family Medicine Physician
  • Clarkston, WA
  • NPI 1083652846
  NPD (past)
• Brandon Lane Whitlock, AG-ACNP

  • Family Nurse Practitioner
  • Clarkston, WA
  • NPI 1124353719
  NPD (past)

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

{
    "created_epoch": "1527811200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1642550400000",
    "number": "1548752918",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "725 DIAGONAL ST",
            "city": "CLARKSTON",
            "state": "WA",
            "postal_code": "994032043",
            "telephone_number": "509-295-8398",
            "fax_number": "509-295-8416"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1625 5TH ST",
            "city": "CLARKSTON",
            "state": "WA",
            "postal_code": "994033001",
            "telephone_number": "509-295-8398",
            "fax_number": "509-295-8416"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "725 Diagonal St",
            "address_purpose": "LOCATION",
            "city": "Clarkston",
            "state": "WA",
            "postal_code": "994032043",
            "country_code": "US",
            "telephone_number": "509-295-8398",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SNAKE RIVER ADULT MEDICINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-01",
        "last_updated": "2022-01-19",
        "certification_date": "2022-01-19",
        "status": "A",
        "authorized_official_last_name": "CIEZKI",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "FRANCIS",
        "authorized_official_title_or_position": "OWNER/OPERATOR",
        "authorized_official_telephone_number": "509-295-8398",
        "authorized_official_credential": "ACNP"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "WA",
            "license": "604282863",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carolyn Jean Shoemaker, PA-C
• Chase Patrick Simpson, CRNA
• Dorothea Skalicky, BS, CDP
• Michelle Lynn Skinner, RD CD
• Mickey Dean Smith, RDH
• David Sperry, LMHC
• Melissa Squires-Williams, LMC
• Elise M Staab, LCPC, LMHC
• Stat Med Solutions PC Inc
• Alexis Amanda Marie Stegner

• Primary Care Clinic/Center in Clarkston, WA
• Providers in Clarkston, WA by specialty
• Primary Care Clinic/Center in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 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.