NPIMap

Organization Active NPI

Puget Sound Gastroenterology, PLLC

Doing business as PSG Division of Pathology

  • Clinical Medical Laboratory
  • Lynnwood, WA
National Provider Identifier
1689646838
Registry record updated May 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
License
600388519 Issued in WA
Legal business name
PUGET SOUND GASTROENTEROLOGY, PLLC
Doing business as
PSG Division of Pathology
Practice address
19000 33Rd Ave W
Suite 230
Lynnwood, WA 98036-4751
Phone
(425) 686-7138
Fax
(425) 745-4104
NPI assigned
Feb 2, 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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X 600388519 WA Primary

Addresses

Primary practice location

19000 33Rd Ave W
Suite 230
Lynnwood, WA 98036-4751

Mailing address

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

Other names 1

  • PSG Division of Pathology 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
Practice locations: Edmonds, WA; Seattle, WA; Olympia, WA; Mill Creek, WA; Lynnwood, WA; Kirkland, WA; Kennewick, WA; Everett, WA

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 6

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
50D1006767PSG Division of Pathology19000 33Rd Ave W Ste 230, Lynnwood, WA 98036AccreditationApr 4, 2028

National Provider Directory

National Provider Directory

Locations

11800 NE 128th St
Ste 100
Kirkland, WA 98034
Phone (425) 899-4500

Practitioners & affiliated clinicians

Practitioners 98

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 98

NPI Registry JSON

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

{
    "created_epoch": "1138838400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747353600000",
    "number": "1689646838",
    "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": "19000 33RD AVE W",
            "address_2": "SUITE 230",
            "city": "LYNNWOOD",
            "state": "WA",
            "postal_code": "980364751",
            "telephone_number": "425-686-7138",
            "fax_number": "425-745-4104"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PUGET SOUND GASTROENTEROLOGY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-02",
        "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": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "WA",
            "license": "600388519",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PSG Division of Pathology",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "PSG Division of Pathology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lynnwood, 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.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.