NPIMap

Organization Active NPI

Fourth Corner Neurosurgical Associates Inc PS

Doing business as Cascade Outpatient Spine Center

  • Neurological Surgery Physician
  • Bellingham, WA
National Provider Identifier
1699846386
Registry record updated Jul 5, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurological Surgery PhysicianTaxonomy code 207T00000X
Legal business name
FOURTH CORNER NEUROSURGICAL ASSOCIATES INC PS
Doing business as
Cascade Outpatient Spine Center
Practice address
710 Birchwood Ave
#101
Bellingham, WA 98225-1720
Phone
(360) 676-0922
Fax
(360) 671-4726
NPI assigned
Nov 13, 2006
Last updated
Jul 5, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
FOURTH CORNER NEUROSURGICAL ASSOCIATES INC PSAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 5, 2022

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

Authorized official

Name
Thomas Richard Flory
Title
Executive Director
Phone
(360) 319-8615

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X
Pain Medicine (Anesthesiology) Physician 207LP2900X
Neurological Surgery Physician 207T00000X WA Primary

Addresses

Primary practice location

710 Birchwood Ave
#101
Bellingham, WA 98225-1720

Mailing address

710 Birchwood Ave
#101
Bellingham, WA 98225-1720
Phone (360) 676-0922

Other names 1

  • Cascade Outpatient Spine Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040311000840 WA Part B Supplier - Clinic/Group Practice 1557250248 Receives reassigned benefits from 8 practitioners
Practice locations: Bellingham, WA

Other NPIs with the same Medicare PAC ID 1

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

National Provider Directory

National Provider Directory
Part of
Fourth Corner Neurosurgical Associates Inc PS

Locations

2940 Squalicum Pkwy
Bellingham, WA 98225
Phone (360) 676-0922

Practitioners & affiliated clinicians

Practitioners 14

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 14

NPI Registry JSON

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

{
    "created_epoch": "1163376000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1656979200000",
    "number": "1699846386",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "710 BIRCHWOOD AVE",
            "address_2": "#101",
            "city": "BELLINGHAM",
            "state": "WA",
            "postal_code": "982251720",
            "telephone_number": "360-676-0922",
            "fax_number": "360-671-4726"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "710 BIRCHWOOD AVE",
            "address_2": "#101",
            "city": "BELLINGHAM",
            "state": "WA",
            "postal_code": "982251720",
            "telephone_number": "360-676-0922",
            "fax_number": "360-671-4726"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOURTH CORNER NEUROSURGICAL ASSOCIATES INC PS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FOURTH CORNER NEUROSURGICAL ASSOCIATES INC PS",
        "enumeration_date": "2006-11-13",
        "last_updated": "2022-07-05",
        "certification_date": "2022-07-05",
        "status": "A",
        "authorized_official_last_name": "FLORY",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "RICHARD",
        "authorized_official_title_or_position": "EXECUTIVE  DIRECTOR",
        "authorized_official_telephone_number": "360-319-8615"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "WA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cascade Outpatient Spine Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Cascade Outpatient Spine Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bellingham, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2022; 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.