NPIMap

Organization Active NPI

Parkview Pediatrics Inc

  • Pediatrics Physician
  • Moses Lake, WA
National Provider Identifier
1609872761
Registry record updated Dec 24, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
MD00026434 Issued in WA
Legal business name
PARKVIEW PEDIATRICS INC
Practice address
615 S Division St
Moses Lake, WA 98837-3800
Phone
(509) 766-9450
Fax
(509) 766-1954
NPI assigned
Jun 23, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 24, 2012

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

Authorized official

Name
Dr. Jill Ann Dudik Bross, MD FAAPNPI 1205837242
Title
Owner/Physician
Phone
(509) 766-9450

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X MD00026434 WA Primary
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X MD0025968 WA
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X MD60174015 WA

Addresses

Primary practice location

615 S Division St
Moses Lake, WA 98837-3800

Mailing address

615 S Division St
Moses Lake, WA 98837-3800
Phone (509) 766-9450

Other identifiers 1

IdentifierTypeStateIssuer
7112600MedicaidWA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1119484800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1356307200000",
    "number": "1609872761",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "615 S DIVISION ST",
            "city": "MOSES LAKE",
            "state": "WA",
            "postal_code": "988373800",
            "telephone_number": "509-766-9450",
            "fax_number": "509-766-1954"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "615 S DIVISION ST",
            "city": "MOSES LAKE",
            "state": "WA",
            "postal_code": "988373800",
            "telephone_number": "509-766-9450",
            "fax_number": "509-766-1954"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARKVIEW PEDIATRICS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-23",
        "last_updated": "2012-12-24",
        "status": "A",
        "authorized_official_last_name": "DUDIK BROSS",
        "authorized_official_first_name": "JILL",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "OWNER/PHYSICIAN",
        "authorized_official_telephone_number": "509-766-9450",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD FAAP"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "WA",
            "license": "MD00026434",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "WA",
            "license": "MD0025968",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "WA",
            "license": "MD60174015",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7112600",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Moses Lake, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 24, 2012; 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.