Prudent Medical Providers NW

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

PRUDENT MEDICAL PROVIDERS NW

Practice address

1045 S 320TH St Ste 7
Federal Way, WA 98003-5179

Phone

(206) 212-6554

NPI assigned

Jan 15, 2021

Organization subpart

No

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

Authorized official

Name

Kristyn Dice

Title

Contracting Manager

Phone

(208) 717-3944

Specialties & licenses 3

Addresses

Other names 1

• N/A Doing business as

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

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

CLIA laboratory certificates

Locations

Practitioners 10

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

• Alnasir Haiderali Adatia, DO

  • Family Medicine Physician
  • Federal Way, WA
  • NPI 1164474227
  Medicare reassignment NPD
• Ubah Gaani, NP

  • Family Nurse Practitioner
  • Seattle, WA
  • NPI 1861913832
  Medicare reassignment NPD
• Miyong Kim, NP

  • Family Nurse Practitioner
  • Tacoma, WA
  • NPI 1790246478
  Medicare reassignment NPD
• Sarah Phillips, AGNP

  • Nurse Practitioner
  • Tacoma, WA
  • NPI 1194377705

  Single Specialty

  Medicare reassignment NPD
• Jorein Teves, ARNP

  • Family Nurse Practitioner
  • Federal Way, WA
  • NPI 1881365435
  Medicare reassignment NPD
• Michael Dan Wingren, MD

  • Family Medicine Physician
  • University Place, WA
  • NPI 1760595664
  Medicare reassignment NPD
• Deborah Denise Finch, RN, MSN, FNP-C

  • Nurse Practitioner
  • Cleveland, TN
  • NPI 1679043574

  WA

  Medicare reassignment NPD
• Junior Germeille

  • Family Nurse Practitioner
  • Lehigh Acres, FL
  • NPI 1477295566

  WA

  Medicare reassignment NPD
• Julia Elizabeth Cathcart-Chang

  • Medical Physician Assistant
  • Lakewood, WA
  • NPI 1174831440
  Medicare reassignment
• Thai Ly, ARNP

  • Nurse Practitioner
  • Tacoma, WA
  • NPI 1346902509
  NPD (past)

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

{
    "created_epoch": "1610668800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1689206400000",
    "number": "1699364455",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4523 42ND ST NE",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984222424",
            "telephone_number": "206-245-4902"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1045 S 320TH ST STE 7",
            "city": "FEDERAL WAY",
            "state": "WA",
            "postal_code": "980035179",
            "telephone_number": "206-212-6554"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4523 42nd St NE",
            "address_purpose": "LOCATION",
            "city": "Tacoma",
            "state": "WA",
            "postal_code": "984222424",
            "country_code": "US",
            "telephone_number": "206-245-4902",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4306 40th Ave NE",
            "address_purpose": "LOCATION",
            "city": "Tacoma",
            "state": "WA",
            "postal_code": "984222488",
            "country_code": "US",
            "telephone_number": "206-245-4902",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PRUDENT MEDICAL PROVIDERS NW",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-15",
        "last_updated": "2023-07-13",
        "certification_date": "2021-07-29",
        "status": "A",
        "authorized_official_last_name": "DICE",
        "authorized_official_first_name": "KRISTYN",
        "authorized_official_title_or_position": "CONTRACTING MANAGER",
        "authorized_official_telephone_number": "208-717-3944"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "N/A",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "N/A",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kami Prentice
• Stephanie R Preston
• Daniel Thomas Price, PT
• Prime Home Health, LLC
• Proliance Surgeons, Inc., P.S.
• Puget Sound Allergy Asthma and Immunology
• Puget Sound Drug Corporation
• Puget Wound Services
• Shalyn Elizabeth Pugh-Davis
• Reyan Pulido

• Family Medicine Physician in Federal Way, WA
• Providers in Federal Way, WA by specialty
• Family Medicine Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2023; 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.