NPIMap

Organization Active NPI

Professional Recreation Organization, Inc.

  • Dermatology Physician
  • Bellevue, WA
National Provider Identifier
1700920782
Registry record updated Aug 7, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
600541508 Issued in WA
Legal business name
PROFESSIONAL RECREATION ORGANIZATION, INC.
Practice address
4455 148TH Ave NE
Bellevue, WA 98007-3120
Phone
(425) 895-6546
Fax
(425) 861-6277
NPI assigned
Feb 16, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 7, 2017

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

Authorized official

Name
Debbie Becker
Title
Sr Director of Accounting
Phone
(425) 869-4746

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207N00000X 600541508 WA Primary
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X 600541508 WA

Addresses

Primary practice location

4455 148TH Ave NE
Bellevue, WA 98007-3120

Mailing address

4455 148TH Ave NE
Bellevue, WA 98007-3120
Phone (425) 895-6546

Other names 1

  • PRO Sports Club Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Pro Sports Club14 organizations share this tax ID, including this one

Other organizations with this tax ID 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1171584000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1502064000000",
    "number": "1700920782",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4455 148TH AVE NE",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980073120",
            "telephone_number": "425-895-6546",
            "fax_number": "425-861-6277"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4455 148TH AVE NE",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980073120",
            "telephone_number": "425-895-6546",
            "fax_number": "425-861-6277"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL RECREATION ORGANIZATION, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-16",
        "last_updated": "2017-08-07",
        "status": "A",
        "authorized_official_last_name": "BECKER",
        "authorized_official_first_name": "DEBBIE",
        "authorized_official_title_or_position": "SR DIRECTOR OF ACCOUNTING",
        "authorized_official_telephone_number": "425-869-4746"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": "WA",
            "license": "600541508",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "600541508",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PRO Sports Club",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bellevue, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.