Active NPI
Franciscan Medical Group
- Orthopaedic Surgery Physician
- Gig Harbor, WA
National Provider Identifier
1639405137
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthopaedic Surgery Physician
- Legal business name
- FRANCISCAN MEDICAL GROUP
- Practice address
- 6401 Kimball Dr FL 2
Gig Harbor, WA 98335-1228 - Phone
- (253) 853-8810
- Fax
- (253) 853-8820
- NPI assigned
- Oct 19, 2009
- Organization subpart
- Yes
- Parent organization
- FRANCISCAN MEDICAL GROUP
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- David Nosacka
- Title
- Cfo
- Phone
- (618) 641-5468
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthopaedic Surgery Physician | 207X00000X | Primary | ||
| Foot & Ankle Surgery Podiatrist | 213ES0103X |
Addresses
Primary practice location
6401 Kimball Dr FL 2
Gig Harbor, WA 98335-1228
Mailing address
6401 Kimball Dr FL 2
Gig Harbor, WA 98335-1228
Phone (253) 853-8810
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7149503 | Medicaid | WA |
Other names 2
- FMG-Gig Harbor Orthopaedic Surgeons
- Franciscan Orthopedic Associates-Gig Harbor
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031111000789 | WA | Part B Supplier - Clinic/Group Practice | 0547173866 |
Receives reassigned benefits from 1,720 practitioners This NPI is an additional NPI on the enrollment |
National Provider Directory
National Provider Directory- Part of
- Enumclaw Medical Center
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1255910400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1663632000000",
"number": "1639405137",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6401 KIMBALL DR FL 2",
"city": "GIG HARBOR",
"state": "WA",
"postal_code": "983351228",
"telephone_number": "253-853-8810",
"fax_number": "253-853-8820"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6401 KIMBALL DR FL 2",
"city": "GIG HARBOR",
"state": "WA",
"postal_code": "983351228",
"telephone_number": "253-853-8810",
"fax_number": "253-853-8820"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "FRANCISCAN MEDICAL GROUP",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "FRANCISCAN MEDICAL GROUP",
"enumeration_date": "2009-10-19",
"last_updated": "2022-09-20",
"certification_date": "2022-09-20",
"status": "A",
"authorized_official_last_name": "NOSACKA",
"authorized_official_first_name": "DAVID",
"authorized_official_title_or_position": "CFO",
"authorized_official_telephone_number": "618-641-5468"
},
"taxonomies": [
{
"code": "207X00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Orthopaedic Surgery",
"state": null,
"license": null,
"primary": true
},
{
"code": "213ES0103X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Podiatrist, Foot & Ankle Surgery",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7149503",
"state": "WA"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "FMG-Gig Harbor Orthopaedic Surgeons",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "FMG-Gig Harbor Orthopaedic Surgeons",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Franciscan Orthopedic Associates-Gig Harbor",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Gig Harbor, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 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.