NPIMap

Organization Active NPI

Puget Sound Kidney Centers

Doing business as Puget Sound Kidney Center Richmond Beach

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Shoreline, WA
National Provider Identifier
1558149807
Registry record updated Sep 18, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
Legal business name
PUGET SOUND KIDNEY CENTERS
Doing business as
Puget Sound Kidney Center Richmond Beach
Practice address
357 NW Richmond Beach Rd
Shoreline, WA 98177-3101
Phone
(425) 259-5195
NPI assigned
Sep 18, 2023
Last updated
Sep 18, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 18, 2023

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

Authorized official

Name
Mary Lou Londerville
Title
Billing & Contracting Manager
Phone
(425) 259-1884

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X NU Primary

Addresses

Primary practice location

357 NW Richmond Beach Rd
Shoreline, WA 98177-3101

Mailing address

1019 Pacific Ave
Everett, WA 98201-4148
Phone (425) 259-5195

Other names 1

  • Puget Sound Kidney Center Richmond Beach Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240227004442 WA Part A Provider - End-Stage Renal Disease Facility (ESRD) 3476501560 Practice locations: Shoreline, WA

Other NPIs with the same Medicare PAC ID 11

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Puget Sound Kidney Centers11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

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

Locations

809 31st St
Anacortes, WA 98221
Phone (360) 755-3586

11950 47th Ave SW
Lakewood, WA 98499
Phone (253) 393-6444

18121 149th St SE
Monroe, WA 98272
Phone (425) 259-5195

430 SE Midway Blvd
Oak Harbor, WA 98277
Phone (360) 679-6706

1476 Olney Ave SE
Port Orchard, WA 98366
Phone (360) 895-7795

Practitioners & affiliated clinicians

Practitioners 3

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": "1694995200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1694995200000",
    "number": "1558149807",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1019 PACIFIC AVE",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982014148",
            "telephone_number": "425-259-5195",
            "fax_number": "425-258-9610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "357 NW RICHMOND BEACH RD",
            "city": "SHORELINE",
            "state": "WA",
            "postal_code": "981773101",
            "telephone_number": "425-259-5195"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PUGET SOUND KIDNEY CENTERS",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-09-18",
        "last_updated": "2023-09-18",
        "certification_date": "2023-09-14",
        "status": "A",
        "authorized_official_last_name": "LONDERVILLE",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "LOU",
        "authorized_official_title_or_position": "BILLING & CONTRACTING MANAGER",
        "authorized_official_telephone_number": "425-259-1884"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Puget Sound Kidney Center Richmond Beach",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Shoreline, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2023; 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.

Verify at the official NPI Registry.