Peacehealth

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

MD00027022 Issued in WA

Legal business name

PEACEHEALTH

Doing business as

PeaceHealth Medical Group

Practice address

505 NE 87TH Ave
Suite 301
Vancouver, WA 98664-1965

Phone

(360) 514-7374

Fax

(360) 514-7384

NPI assigned

Sep 10, 2007

Last updated

Mar 8, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Darrin Montalvo

Title

Evp Chief Finan-Growth Officer

Phone

(360) 729-1102

Specialties & licenses 1

Addresses

Other names 1

• PeaceHealth Medical Group Doing business as

Medicare fee-for-service enrollment

Enrolled in WA, IL, NC, GA, TX, NY, NJ7 enrollments

Enrollment records 7

Other NPIs with the same Medicare PAC ID 1

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

• Peacehealth

  dba Peacehealth Medical Group-Optical Shop Vancouver Network

  • Durable Medical Equipment & Medical Supplies
  • Vancouver, WA
  • NPI 1992182380

  8820178288

  Same PAC ID

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Peacehealth

  dba PeaceHealth Home Health of Whatcom County

  • Home Health Agency
  • Bellingham, WA
  • NPI 1710639901

  Member Of

  NPD member

Locations

Practitioners 387

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.

• Kristopher Kurtis Adams

  • Clinical Psychologist
  • Vancouver, WA
  • NPI 1679197370
  Medicare reassignment Care Compare group NPD
• Connie Ahn, NP

  • Family Nurse Practitioner
  • Vancouver, WA
  • NPI 1104493865
  Medicare reassignment Care Compare group NPD
• Jordan James Allensworth

  • Otolaryngology Physician
  • Vancouver, WA
  • NPI 1912347675
  Medicare reassignment Care Compare group NPD
• Jamil Shafiq Amlani, M.D.

  • Internal Medicine Physician
  • Vancouver, WA
  • NPI 1477179075
  Medicare reassignment Care Compare group NPD
• Nathan Franklin Amrine, MD

  • Obstetrics & Gynecology Physician
  • Vancouver, WA
  • NPI 1821354424
  Medicare reassignment Care Compare group NPD
• Naa Afadua Annoh

  • Adult Health Nurse Practitioner
  • Everett, WA
  • NPI 1588140073
  Medicare reassignment Care Compare group NPD
• Jaime Aranda-Michel, MD

  • Gastroenterology Physician
  • Vancouver, WA
  • NPI 1093704959
  Medicare reassignment Care Compare group NPD
• Kevin Ransom Au, M.D.

  • Vascular Surgery Physician
  • Vancouver, WA
  • NPI 1417344219
  Medicare reassignment Care Compare group NPD
• Sholeh Bagheri, M.D.

  • Pulmonary Disease Physician
  • Longview, WA
  • NPI 1285746875
  Medicare reassignment Care Compare group NPD
• Zoe Bartynski, MD

  • Family Medicine Physician
  • Vancouver, WA
  • NPI 1073257150
  Medicare reassignment Care Compare group NPD
• Sarice L Bassin, M.D.

  • Neurology Physician
  • Vancouver, WA
  • NPI 1689691370
  Medicare reassignment Care Compare group NPD
• Corey Gregory Batiste, M.D.

  • Ophthalmology Physician
  • Vancouver, WA
  • NPI 1235180696
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1189382400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1615161600000",
    "number": "1609061969",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1115 SE 164TH AVE",
            "address_2": "DEPT 358",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986839324",
            "telephone_number": "360-729-1412",
            "fax_number": "360-501-7555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "505 NE 87TH AVE",
            "address_2": "SUITE 301",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986641965",
            "telephone_number": "360-514-7374",
            "fax_number": "360-514-7384"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEACEHEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-10",
        "last_updated": "2021-03-08",
        "certification_date": "2021-03-08",
        "status": "A",
        "authorized_official_last_name": "MONTALVO",
        "authorized_official_first_name": "DARRIN",
        "authorized_official_title_or_position": "EVP CHIEF FINAN-GROWTH OFFICER",
        "authorized_official_telephone_number": "360-729-1102"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "WA",
            "license": "MD00027022",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PeaceHealth Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Peacehealth (Peacehealth Southwest Home Health)
• Peacehealth
• Peacehealth (PeaceHealth Southwest Inpatient Rehabilitation)
• Peacehealth (Peacehealth Southwest Hospice)
• Peacehealth (PeaceHealth Southwest Pharmacy at Medical Center)
• Peacehealth
• Peacehealth (Peacehealth Medical Group-Optical Shop Vancouver Network)
• Peacehealth Networks on Demand, LLC (ZoomCare- The Mill)
• Peacehealth Networks on Demand, LLC (ZoomCare- Vancouver Waterfront)
• Peacehealth Networks on Demand, LLC (ZoomCare- Salmon Creek)

• Surgery Physician in Vancouver, WA
• Providers in Vancouver, WA by specialty
• Surgery Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2021; 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.