NPIMap

Organization Active NPI

Prime Care PLLC

  • Internal Medicine Physician
  • Bothell, WA
National Provider Identifier
1578035200
Registry record updated Feb 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
PRIME CARE PLLC
Practice address
11812 N Creek Pkwy N Ste 202
Bothell, WA 98011-8202
Phone
(206) 538-6300
Fax
(206) 538-6301
NPI assigned
Dec 19, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 9, 2023

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

Authorized official

Name
Kevin Moon
Title
Contracting Coordinator
Phone
(206) 538-6300

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207R00000X Primary
Interventional Pain Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208VP0014X
Nurse PractitionerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 363L00000X
Family Nurse PractitionerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 363LF0000X

Addresses

Primary practice location

11812 N Creek Pkwy N Ste 202
Bothell, WA 98011-8202

Mailing address

801 SW 16TH St Ste 121
Renton, WA 98057-2628
Phone (206) 538-6300

National Provider Directory

National Provider Directory

Locations

11812 N Creek Pkwy N
Ste 202
Bothell, WA 98011
Phone (425) 287-5500

801 SW 16th St
Ste 121
Renton, WA 98057
Phone (206) 805-8885

Practitioners & affiliated clinicians

Practitioners 5

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

NPI Registry JSON

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

{
    "created_epoch": "1545177600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1675900800000",
    "number": "1578035200",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 SW 16TH ST STE 121",
            "city": "RENTON",
            "state": "WA",
            "postal_code": "980572628",
            "telephone_number": "206-538-6300",
            "fax_number": "206-538-6301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11812 N CREEK PKWY N STE 202",
            "city": "BOTHELL",
            "state": "WA",
            "postal_code": "980118202",
            "telephone_number": "206-538-6300",
            "fax_number": "206-538-6301"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIME CARE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-12-19",
        "last_updated": "2023-02-09",
        "certification_date": "2023-02-09",
        "status": "A",
        "authorized_official_last_name": "MOON",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "CONTRACTING COORDINATOR",
        "authorized_official_telephone_number": "206-538-6300"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bothell, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2023; 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.