NPIMap

Organization Active NPI

Cascade Clinic Walk in and Primary Care LLC

Doing business as Cascade Clinic

  • Primary Care Clinic/Center
  • Mount Vernon, WA
National Provider Identifier
1609121854
Registry record updated May 7, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
CASCADE CLINIC WALK IN AND PRIMARY CARE LLC
Doing business as
Cascade Clinic
Cascade Clinic Work Injury and Primary Care
Practice address
1420 Roosevelt Ave Ste 4
Mount Vernon, WA 98273-2687
Phone
(360) 899-4086
Fax
(360) 899-4124
NPI assigned
Jul 13, 2012
Last updated
May 7, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 7, 2020

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

Authorized official

Name
Kathy Bradford, ARNPNPI 1871802769
Title
Owner
Phone
(360) 770-4690

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X Primary

Addresses

Primary practice location

1420 Roosevelt Ave Ste 4
Mount Vernon, WA 98273-2687

Mailing address

1420 Roosevelt Ave Ste 4
Mount Vernon, WA 98273-2687
Phone (608) 994-0863

Other identifiers 1

IdentifierTypeStateIssuer
321303OtherWALABOR AND INDUSTRIES

Other names 2

  • Cascade Clinic Doing business as
  • Cascade Clinic Work Injury and Primary Care Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120813000105 WA Part B Supplier - Clinic/Group Practice 4486800141 Receives reassigned benefits from 5 practitioners
Practice locations: Mount Vernon, WA

National Provider Directory

National Provider Directory

Locations

1420 Roosevelt Ave
Ste 4
Mount Vernon, WA 98273
Phone (360) 899-4086

500 W State St
Ste A
Sedro Woolley, WA 98284
Phone (360) 899-4056

901 Metcalf St
Sedro Woolley, WA 98284

Practitioners & affiliated clinicians

Practitioners 15

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.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1342137600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1588809600000",
    "number": "1609121854",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1420 ROOSEVELT AVE STE 4",
            "city": "MOUNT VERNON",
            "state": "WA",
            "postal_code": "982732687",
            "telephone_number": "608-994-0863",
            "fax_number": "360-899-4124"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1420 ROOSEVELT AVE STE 4",
            "city": "MOUNT VERNON",
            "state": "WA",
            "postal_code": "982732687",
            "telephone_number": "360-899-4086",
            "fax_number": "360-899-4124"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CASCADE CLINIC WALK IN AND PRIMARY CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-13",
        "last_updated": "2020-05-07",
        "certification_date": "2020-05-07",
        "status": "A",
        "authorized_official_last_name": "BRADFORD",
        "authorized_official_first_name": "KATHY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "360-770-4690",
        "authorized_official_credential": "ARNP"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LABOR AND INDUSTRIES",
            "identifier": "321303",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cascade Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Cascade Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Cascade Clinic Work Injury and Primary Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mount Vernon, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2020; 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.