Proliance Surgeons, Inc., P.S.

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

Legal business name

PROLIANCE SURGEONS, INC., P.S.

Practice address

1500 Continental PL
Mount Vernon, WA 98273-4105

Phone

(360) 424-7041

Fax

(360) 424-2418

NPI assigned

Dec 9, 2013

Organization subpart

No

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

Authorized official

Name

Cori M. Pleasant

Title

MGR Provider Relations/Enrollment

Phone

(206) 838-2585

Specialties & licenses 7

Addresses

Other identifiers 2

Other names 1

• Proliance Surgeons Skagit Northwest Orthopedics/Physical Therapy Doing business as

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

Locations

Practitioners 22

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• John M Blair Jr., M.D.

  • Orthopaedic Surgery of the Spine Physician
  • Tacoma, WA
  • NPI 1700985611
  NPD
• Gary L Brown, M.D.

  • Otolaryngology Physician
  • Mount Vernon, WA
  • NPI 1295706752
  NPD
• Jordan Scott Clapper, PA-C

  • Medical Physician Assistant
  • Anacortes, WA
  • NPI 1306435995

  Surgical

  NPD
• Brynne Dykes, DPT

  • Physical Therapist
  • Bellingham, WA
  • NPI 1700522448
  NPD
• Scott Michael Ely, PA-C

  • Surgical Physician Assistant
  • Mount Vernon, WA
  • NPI 1437448958
  NPD
• Sean Ghidella, MD

  • Orthopaedic Hand Surgery Physician
  • Lakewood, WA
  • NPI 1538135322
  NPD
• Krista Elizabeth Guyll, PA-C

  • Surgical Physician Assistant
  • Lakewood, WA
  • NPI 1376910125
  NPD
• Lee A Haggerty, DPT

  • Physical Therapist
  • Bellingham, WA
  • NPI 1083239446
  NPD
• Monica Huang, PA-C

  • Surgical Physician Assistant
  • Tacoma, WA
  • NPI 1215407770
  NPD
• Gary K Johnson, M.D.

  • Otolaryngology Physician
  • Mount Vernon, WA
  • NPI 1437129186
  NPD
• Andrew B Kopstein, MD

  • Ophthalmology Physician
  • Tacoma, WA
  • NPI 1124050117
  NPD
• Morgan Lynn Laroque, PA-C

  • Surgical Physician Assistant
  • Lakewood, WA
  • NPI 1497217558
  NPD

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

{
    "created_epoch": "1386547200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1661385600000",
    "number": "1629409297",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1401 S LAVENTURE RD",
            "city": "MOUNT VERNON",
            "state": "WA",
            "postal_code": "982746033",
            "telephone_number": "360-424-7041"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 CONTINENTAL PL",
            "city": "MOUNT VERNON",
            "state": "WA",
            "postal_code": "982734105",
            "telephone_number": "360-424-7041",
            "fax_number": "360-424-2418"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROLIANCE SURGEONS, INC., P.S.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-12-09",
        "last_updated": "2022-08-25",
        "certification_date": "2022-08-25",
        "status": "A",
        "authorized_official_last_name": "PLEASANT",
        "authorized_official_first_name": "CORI",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "MGR PROVIDER RELATIONS/ENROLLMENT",
        "authorized_official_telephone_number": "206-838-2585"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery",
            "state": "WA",
            "license": "601484763",
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "WA",
            "license": "601484763",
            "primary": false
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "WA",
            "license": "601484763",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "601484763",
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant, Surgical",
            "state": "WA",
            "license": "601484763",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WA LABOR & INDUSTRIES",
            "identifier": "121724",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1042545",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Proliance Surgeons Skagit Northwest Orthopedics/Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Proliance Surgeons Inc P S
• Proliance Surgeons, Inc., P.S.
• Proliance Surgeons, Inc., P.S.
• Proliance Surgeons, Inc., P.S.
• Proliance Surgeons, Inc., P.S.
• Proliance Surgeons, Inc., P.S.
• Christopher Prompuntagorn, MD
• Psychiatric Nurse Consulting & Therapy, LLC
• Public Hospital Dist No 1 Skagit
• Public Hospital Dist No 1 Skagit

• Multi-Specialty Clinic/Center in Mount Vernon, WA
• Providers in Mount Vernon, WA by specialty
• Multi-Specialty Clinic/Center in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2022; 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.