NPIMap

Organization Active NPI

Pain Care Physicians PLLC

  • Ambulatory Surgical Clinic/Center
  • Olympia, WA
National Provider Identifier
1619530839
Registry record updated Jul 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
Legal business name
PAIN CARE PHYSICIANS PLLC
Practice address
155 Lilly Rd NE Ste B
Olympia, WA 98506-5028
Phone
(206) 538-6300
Fax
(206) 538-6301
NPI assigned
Apr 15, 2019
Last updated
Jul 21, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2025

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

Authorized official

Name
Kevin Moon
Title
Director of Revenue and Finance
Phone
(206) 538-6300

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine Physician 208VP0000X
Interventional Pain Medicine Physician 208VP0014X
Ambulatory Surgical Clinic/Center 261QA1903X Primary

Addresses

Primary practice location

155 Lilly Rd NE Ste B
Olympia, WA 98506-5028

Mailing address

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

Other identifiers 2

IdentifierTypeStateIssuer
50C0001329OtherWAMEDICARE CERTIFICATION NUMBER
1144779232OtherBILLING NPI

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20161107001926 WA Part B Supplier - Clinic/Group Practice 9537448931 Receives reassigned benefits from 18 practitioners
7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Everett, WA; Bellevue, WA; Tacoma, WA; Spokane Valley, WA; Olympia, WA; Renton, WA

Other NPIs on the same Medicare enrollment 6

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

National Provider Directory

National Provider Directory
Tax ID family
Pain Care Physicians PLLC6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the 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, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1555286400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1753056000000",
    "number": "1619530839",
    "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": "155 LILLY RD NE STE B",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985065028",
            "telephone_number": "206-538-6300",
            "fax_number": "206-538-6301"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAIN CARE PHYSICIANS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-04-15",
        "last_updated": "2025-07-21",
        "certification_date": "2025-07-21",
        "status": "A",
        "authorized_official_last_name": "MOON",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "DIRECTOR OF REVENUE AND FINANCE",
        "authorized_official_telephone_number": "206-538-6300"
    },
    "taxonomies": [
        {
            "code": "208VP0000X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE CERTIFICATION NUMBER",
            "identifier": "50C0001329",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BILLING NPI",
            "identifier": "1144779232",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Olympia, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2025; 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.