NPIMap

Organization Active NPI

Western Washington Medical Group Inc PS

Doing business as WWMG Dept of Neurology

  • Neurocritical Care Physician
  • Everett, WA
National Provider Identifier
1568916682
Registry record updated Jun 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurocritical Care PhysicianTaxonomy code 2084A2900X
Legal business name
WESTERN WASHINGTON MEDICAL GROUP INC PS
Doing business as
WWMG Dept of Neurology
WWMG Dept of Neurology Hospitalist
Practice address
12728 19TH Ave SE
Suite 300
Everett, WA 98208-6526
Phone
(425) 259-4041
NPI assigned
Aug 5, 2016
Last updated
Jun 19, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 19, 2024

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

Authorized official

Name
Elizabeth Bae
Title
Contract Analyst/Credentialing Coor
Phone
(425) 259-4041

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X NU
Neurocritical Care Physician 2084A2900X NU Primary

Addresses

Primary practice location

12728 19TH Ave SE
Suite 300
Everett, WA 98208-6526

Mailing address

1728 W Marine View Dr
Suite 110
Everett, WA 98201-2094
Phone (425) 259-4041

Other names 2

  • WWMG Dept of Neurology Doing business as
  • WWMG Dept of Neurology Hospitalist Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031107000469 WA Part B Supplier - Clinic/Group Practice 7517870314 Receives reassigned benefits from 130 practitioners
32 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Everett, WA; Lynnwood, WA; Marysville, WA; Monroe, WA; Oak Harbor, WA; Snohomish, WA; Anacortes, WA; Arlington, WA…

Other NPIs on the same Medicare enrollment 32

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 32

National Provider Directory

National Provider Directory
Tax ID family
W Wa Med Group Opthalmo21 organizations share this tax ID, including this one

Other organizations with this tax ID 20

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

View all 20

Practitioners & affiliated clinicians

Practitioners 4

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": "1470355200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718755200000",
    "number": "1568916682",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1728 W MARINE VIEW DR",
            "address_2": "SUITE 110",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982012094",
            "telephone_number": "425-259-4041"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12728 19TH AVE SE",
            "address_2": "SUITE 300",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982086526",
            "telephone_number": "425-259-4041"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WESTERN WASHINGTON MEDICAL GROUP INC PS",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-05",
        "last_updated": "2024-06-19",
        "certification_date": "2024-06-17",
        "status": "A",
        "authorized_official_last_name": "BAE",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_title_or_position": "CONTRACT ANALYST/CREDENTIALING COOR",
        "authorized_official_telephone_number": "425-259-4041"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2084A2900X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurocritical Care",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WWMG Dept of Neurology",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "WWMG Dept of Neurology",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "WWMG Dept of Neurology Hospitalist",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Everett, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2024; 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.