NPIMap

Organization Active NPI

Western Washington Medical Group, Inc PS

Doing business as Western Wa Medical Group, Dept of Primary Care

  • Family Medicine Physician
  • Everett, WA
National Provider Identifier
1649498049
Registry record updated Aug 8, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
601474013 Issued in WA
Legal business name
WESTERN WASHINGTON MEDICAL GROUP, INC PS
Doing business as
Western Wa Medical Group, Dept of Primary Care
Practice address
4225 Hoyt Ave Ste D
Everett, WA 98203-2351
Phone
(425) 317-8025
Fax
(425) 317-9516
NPI assigned
Apr 23, 2007
Last updated
Aug 8, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
WESTERN WASHINGTOM MEDICAL GROUPAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 8, 2023

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

Authorized official

Name
Amelia Edens
Title
Director of Patient Financial SVCS
Phone
(425) 740-4142

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 601474013 WA Primary

Addresses

Primary practice location

4225 Hoyt Ave Ste D
Everett, WA 98203-2351

Mailing address

1728 W Marine View Dr Ste 110
Everett, WA 98201-2094
Phone (425) 317-8025

Other identifiers 3

IdentifierTypeStateIssuer
7108012MedicaidWA
CB3566OtherWARAILROAD MEDICARE
0176782OtherWALABOR & INDUSTRY

Other names 1

  • Western Wa Medical Group, Dept of Primary Care Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031107000469 WA Part B Supplier - Clinic/Group Practice 7517870314 Receives reassigned benefits from 130 practitioners
32 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Everett, WA; Lynnwood, WA; Marysville, WA; Monroe, WA; Oak Harbor, WA; Snohomish, WA; Anacortes, WA; Arlington, WA…

Other NPIs on the same Medicare enrollment 32

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

View all 32

National Provider Directory

National Provider Directory
Part of
W Wa Med Group Opthalmo

Locations

4225 Hoyt Ave
Ste B
Everett, WA 98203
Phone (425) 252-6666

629 Avenue D
Snohomish, WA 98290
Phone (360) 568-1551

Practitioners & affiliated clinicians

Practitioners 13

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 13

NPI Registry JSON

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

{
    "created_epoch": "1177286400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1691452800000",
    "number": "1649498049",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1728 W MARINE VIEW DR STE 110",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982012094",
            "telephone_number": "425-317-8025",
            "fax_number": "425-317-9516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4225 HOYT AVE STE D",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982032351",
            "telephone_number": "425-317-8025",
            "fax_number": "425-317-9516"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WESTERN WASHINGTON MEDICAL GROUP, INC PS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WESTERN WASHINGTOM MEDICAL GROUP",
        "enumeration_date": "2007-04-23",
        "last_updated": "2023-08-08",
        "certification_date": "2023-08-04",
        "status": "A",
        "authorized_official_last_name": "EDENS",
        "authorized_official_first_name": "AMELIA",
        "authorized_official_title_or_position": "DIRECTOR OF PATIENT FINANCIAL SVCS",
        "authorized_official_telephone_number": "425-740-4142"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "601474013",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7108012",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CB3566",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LABOR & INDUSTRY",
            "identifier": "0176782",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Western Wa Medical Group, Dept of Primary Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Everett, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2023; 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.