NPIMap

Organization Active NPI

Valley Medical Group-Renton

  • General Acute Care Hospital
  • Renton, WA
National Provider Identifier
1619209574
Registry record updated Mar 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
License
H-155 Issued in WA
Legal business name
VALLEY MEDICAL GROUP-RENTON
Practice address
400 S 43Rd St
Renton, WA 98055-5714
Phone
(425) 228-3440
Fax
(425) 656-5565
NPI assigned
Feb 3, 2010
Last updated
Mar 22, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
PUBLIC HOSPITAL DISTRICT #1 OF KING COUNTYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 22, 2023

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

Authorized official

Name
Michele Forgues Lackie
Title
Senior Vice President Finance/Cfo
Phone
(425) 690-6677

Specialties & licenses 15

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X H-155 WA Primary
Nurse Practitioner 363L00000X H-155 WA
Advanced Practice Midwife 367A00000X H-155 WA
Family Medicine Physician 207Q00000X H-155 WA
Internal Medicine Physician 207R00000X H-155 WA
Neurological Surgery Physician 207T00000X H-155 WA
Gynecology Physician 207VG0400X H-155 WA
Ophthalmology Physician 207W00000X H-155 WA
Pediatrics Physician 208000000X H-155 WA
Physical Medicine & Rehabilitation Physician 208100000X NU
Neurology Physician 2084N0400X H-155 WA
Surgery Physician 208600000X H-155 WA
Vascular Surgery Physician 2086S0129X H-155 WA
Hospitalist Physician 208M00000X H-155 WA
Community/Behavioral Health Agency 251S00000X NU

Addresses

Primary practice location

400 S 43Rd St
Renton, WA 98055-5714

Mailing address

PO Box 34876
Seattle, WA 98124-1876
Phone (425) 656-5412

Other identifiers 1

IdentifierTypeStateIssuer
1008494MedicaidWA

Other names 1

  • Public Hospital District #1 of King County Other name

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20080513000214 WA Part A Provider - Hospital 6901700731 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Renton, WA
O20100604000113 WA Part B Supplier - Clinic/Group Practice 4183753965 Receives reassigned benefits from 767 practitioners
Practice locations: Seattle, WA; Renton, WA; Newcastle, WA; Auburn, WA; Covington, WA; Kent, WA; Maple Valley, WA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1619209574. Details of each certification follow.

Hospital certification: CCN 500088

Legal name
PUBLIC HOSPITAL DISTRICT 1 OF KING COUNTY
Doing business as
VALLEY MEDICAL CENTER
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jun 26, 1981
Last certification
May 12, 2011
Beds
303
Ownership / control type
Hospital district or authority
Organization structure
GovernmentNon-profit
Incorporated
Mar 19, 1985 in WA
Enrollment address
400 S 43Rd St
Renton, WA 98055-5714
Other Hospital Practice Location
Hospital subgroups
Acute care

Other NPIs on the same Medicare enrollment 1

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Valley Medical CenterCCN 500088 · All quality measures
Overall star rating
2 of 5
Type
Acute Care Hospitals
Ownership
Government - Hospital District or Authority
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Part of
Valley Medical Center

Locations

24920 104th Ave SE
Kent, WA 98030
Phone (253) 395-1985

521 2nd Pl N
#11103
Kent, WA 98032
Phone (425) 690-3491

26458 Maple Valley Black Diamond Rd SE
Maple Valley, WA 98038
Phone (425) 656-5577

7203 129th Ave SE
Newcastle, WA 98056
Phone (425) 656-5406

17722 Talbot Rd S
Ste 100
Renton, WA 98055
Phone (425) 228-0722

3901 NE 4th St
Ste 105
Renton, WA 98056
Phone (425) 656-5377

3915 Talbot Rd S
Renton, WA 98055
Phone (425) 630-3400

3915 Talbot Rd S
Ste 100
Renton, WA 98055
Phone (425) 656-5345

3915 Talbot Rd S
Ste 300
Renton, WA 98055
Phone (425) 656-5570

4033 Talbot Rd S
Ste 450
Renton, WA 98055
Phone (425) 271-4910

4033 Talbot Rd S
Ste 500
Renton, WA 98055
Phone (425) 251-5110

425 SW 41st St
Renton, WA 98057
Phone (425) 226-1190

4300 Talbot Rd S
Ste 400
Renton, WA 98055
Phone (425) 235-9911

4445 Talbot Rd S
Ste 1
Renton, WA 98055

451 Duvall Ave NE
#104
Renton, WA 98059
Phone (425) 656-5500

1550 N 115th St
#G5
Seattle, WA 98133
Phone (206) 386-1626

Ownership & related parties

All disclosed owners & managing parties 5

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Patricia Kyle Individual W-2 Managing Employee Dec 3, 2007
Michele Fisher Individual Corporate OfficerChief Financial Officer Dec 31, 2021 10%
Judy Skaer Individual W-2 Managing Employee Dec 5, 2016
Public Hospital District 1 of King County Organization, Renton, WA Non-profit 5% Or Greater Direct Ownership Interest Jan 1, 1966 100%
Jeannine Grinnell Individual Corporate OfficerChief Executive Officer Jun 1, 2010 20%

Owners & managing parties with NPI records 3

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 777

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 777

Affiliated clinicians 675

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 675

NPI Registry JSON

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

{
    "created_epoch": "1265155200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1679443200000",
    "number": "1619209574",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 34876",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981241876",
            "telephone_number": "425-656-5412",
            "fax_number": "425-656-4096"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 S 43RD ST",
            "city": "RENTON",
            "state": "WA",
            "postal_code": "980555714",
            "telephone_number": "425-228-3440",
            "fax_number": "425-656-5565"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VALLEY MEDICAL GROUP-RENTON",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PUBLIC HOSPITAL DISTRICT #1 OF KING COUNTY",
        "enumeration_date": "2010-02-03",
        "last_updated": "2023-03-22",
        "certification_date": "2023-03-22",
        "status": "A",
        "authorized_official_last_name": "FORGUES LACKIE",
        "authorized_official_first_name": "MICHELE",
        "authorized_official_title_or_position": "SENIOR VICE PRESIDENT FINANCE/CFO",
        "authorized_official_telephone_number": "425-690-6677"
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "WA",
            "license": "H-155",
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WA",
            "license": "H-155",
            "primary": false
        },
        {
            "code": "367A00000X",
            "taxonomy_group": "",
            "desc": "Advanced Practice Midwife",
            "state": "WA",
            "license": "H-155",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "H-155",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WA",
            "license": "H-155",
            "primary": false
        },
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "WA",
            "license": "H-155",
            "primary": false
        },
        {
            "code": "207VG0400X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Gynecology",
            "state": "WA",
            "license": "H-155",
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "WA",
            "license": "H-155",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "WA",
            "license": "H-155",
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "WA",
            "license": "H-155",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "WA",
            "license": "H-155",
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "WA",
            "license": "H-155",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "WA",
            "license": "H-155",
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1008494",
            "state": "WA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "N",
            "endpointDescription": "2.16.840.1.113883.3.1068.1",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "2720 Dundee Rd Ste 302",
            "city": "Northbrook",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600622609",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Public Hospital District #1 of King County",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Public Hospital District #1 of King County",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Renton, WA

Sources for this page

Verify at the official NPI Registry.