NPIMap

Organization Active NPI

Western Washington Medical Group Inc PS

  • Registered Dietitian
  • Bothell, WA
National Provider Identifier
1649535642
Registry record updated Sep 23, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
Legal business name
WESTERN WASHINGTON MEDICAL GROUP INC PS
Practice address
1909 214TH St SE
Suite 211
Bothell, WA 98021-4412
Phone
(425) 259-4041
NPI assigned
Jul 6, 2012
Organization subpart
Yes
Parent organization
WESTERN WASHINGTON MEDICAL GROUPAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 23, 2016

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

Authorized official

Name
Kim Holstein
Title
Director PFS
Phone
(425) 259-4041

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered DietitianGroup: 193200000X MULTI-SPECIALTY GROUP 133V00000X WA Primary

Addresses

Primary practice location

1909 214TH St SE
Suite 211
Bothell, WA 98021-4412

Mailing address

1728 W Marine View Dr
Everett, WA 98201-2094
Phone (425) 259-4041

Other names 1

  • WWMG Diabetic Education 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
Tax ID family
Western Washington Med GRP21 organizations share this tax ID, including this one
Part of
Western Washington Med GRP

Other organizations with this tax ID 20

Organizations that report the same tax identification number in the National Provider Directory.

View all 20

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1341532800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1474588800000",
    "number": "1649535642",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1728 W MARINE VIEW DR",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982012094",
            "telephone_number": "425-259-4041"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1909 214TH ST SE",
            "address_2": "SUITE 211",
            "city": "BOTHELL",
            "state": "WA",
            "postal_code": "980214412",
            "telephone_number": "425-259-4041"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WESTERN WASHINGTON MEDICAL GROUP INC PS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WESTERN WASHINGTON MEDICAL GROUP",
        "enumeration_date": "2012-07-06",
        "last_updated": "2016-09-23",
        "status": "A",
        "authorized_official_last_name": "HOLSTEIN",
        "authorized_official_first_name": "KIM",
        "authorized_official_title_or_position": "DIRECTOR PFS",
        "authorized_official_telephone_number": "425-259-4041"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dietitian, Registered",
            "state": "WA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WWMG Diabetic Education",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bothell, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2016; 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.