NPIMap

Organization Active NPI

Capital Medical Center Physicians LLC

  • Internal Medicine Physician
  • Montesano, WA
National Provider Identifier
1710744792
Registry record updated Aug 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
CAPITAL MEDICAL CENTER PHYSICIANS LLC
Practice address
112 E Broadway Ave
Montesano, WA 98563-3704
Phone
(360) 249-4111
Fax
(360) 249-5220
NPI assigned
Mar 5, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 4, 2025

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

Authorized official

Name
William Glenn Robertson
Title
Ceo
Phone
(253) 403-1272

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

112 E Broadway Ave
Montesano, WA 98563-3704

Mailing address

P.O. Box 5299
Ms: 820-5-Pco
Tacoma, WA 98415-0299

Other names 1

  • Montesano Internal Medicine by MultiCare Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090312000311 WA Part B Supplier - Clinic/Group Practice 3678639879 Receives reassigned benefits from 89 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Lacey, WA; Montesano, WA; Olympia, WA; Tumwater, WA

Other NPIs on the same Medicare enrollment 3

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

National Provider Directory

National Provider Directory
Tax ID family
Capital Medical Center Physicians LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

130 Marvin Rd SE
Ste 112
Olympia, WA 98503
Phone (360) 357-8822

Practitioners & affiliated clinicians

Practitioners 90

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

View all 90

NPI Registry JSON

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

{
    "created_epoch": "1709596800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1754265600000",
    "number": "1710744792",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 5299",
            "address_2": "MS: 820-5-PCO",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984150299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 E BROADWAY AVE",
            "city": "MONTESANO",
            "state": "WA",
            "postal_code": "985633704",
            "telephone_number": "360-249-4111",
            "fax_number": "360-249-5220"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAPITAL MEDICAL CENTER PHYSICIANS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-03-05",
        "last_updated": "2025-08-04",
        "certification_date": "2025-08-04",
        "status": "A",
        "authorized_official_last_name": "ROBERTSON",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "GLENN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "253-403-1272"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Montesano Internal Medicine by MultiCare",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Montesano Internal Medicine by MultiCare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Montesano, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2025; 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.