NPIMap

Organization Active NPI

Puget Sound Gastroenterology, PLLC

Doing business as Seattle Gastroenterology Associates

  • Gastroenterology Physician
  • Seattle, WA
National Provider Identifier
1649212606
Registry record updated May 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
Legal business name
PUGET SOUND GASTROENTEROLOGY, PLLC
Doing business as
Seattle Gastroenterology Associates
Practice address
11027 Meridian Ave N
Suite 100
Seattle, WA 98133-1705
Phone
(206) 365-4492
Fax
(206) 368-3456
NPI assigned
Jun 12, 2006
Last updated
May 16, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 16, 2025

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

Authorized official

Name
Alan Oliver, CEO
Title
Ceo
Phone
(786) 530-3820

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X WA Primary
Clinical Medical Laboratory 291U00000X 600388519 WA

Addresses

Primary practice location

11027 Meridian Ave N
Suite 100
Seattle, WA 98133-1705

Mailing address

PO Box 34888
Seattle, WA 98124-1888
Phone (425) 977-4620

Other identifiers 2

IdentifierTypeStateIssuer
1045049MedicaidWA
0031330OtherWALABOR AND INDUSTRIES

Other names 1

  • Seattle Gastroenterology Associates Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040301000478 WA Part B Supplier - Clinic/Group Practice 1759278252 Receives reassigned benefits from 95 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Edmonds, WA; Seattle, WA; Olympia, WA; Mill Creek, WA; Lynnwood, WA; Kirkland, WA; Kennewick, WA; Everett, 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

Practitioners & affiliated clinicians

Practitioners 10

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": "1150070400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747353600000",
    "number": "1649212606",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 34888",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981241888",
            "telephone_number": "425-977-4620",
            "fax_number": "425-745-9836"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11027 MERIDIAN AVE N",
            "address_2": "SUITE 100",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981331705",
            "telephone_number": "206-365-4492",
            "fax_number": "206-368-3456"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PUGET SOUND GASTROENTEROLOGY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-12",
        "last_updated": "2025-05-16",
        "certification_date": "2025-05-16",
        "status": "A",
        "authorized_official_last_name": "OLIVER",
        "authorized_official_first_name": "ALAN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "786-530-3820",
        "authorized_official_credential": "CEO"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "WA",
            "license": null,
            "primary": true
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "WA",
            "license": "600388519",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1045049",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LABOR AND INDUSTRIES",
            "identifier": "0031330",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Seattle Gastroenterology Associates",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Seattle Gastroenterology Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Seattle, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 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.