NPIMap

Organization Active NPI

Western Washington Medical Group, Inc PS

Doing business as WWMG Dept of Imaging

  • Radiology Clinic/Center
  • Everett, WA
National Provider Identifier
1720430903
Registry record updated Jul 10, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiology Clinic/CenterTaxonomy code 261QR0200X
Legal business name
WESTERN WASHINGTON MEDICAL GROUP, INC PS
Doing business as
WWMG Dept of Imaging
Practice address
3822 Colby Ave
Suite 100
Everett, WA 98201-4913
Phone
(425) 259-4041
NPI assigned
Jul 12, 2016
Last updated
Jul 10, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2017

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

Authorized official

Name
Kim Holstein
Title
Director
Phone
(425) 259-4041

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Radiology Clinic/Center 261QR0200X Primary

Addresses

Primary practice location

3822 Colby Ave
Suite 100
Everett, WA 98201-4913

Mailing address

1728 W Marine View Dr
Suite 110
Everett, WA 98201-2094
Phone (425) 259-4041

Other names 1

  • WWMG Dept of Imaging Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031107000469 WA Part B Supplier - Clinic/Group Practice 7517870314 Receives reassigned benefits from 130 practitioners
32 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Everett, WA; Lynnwood, WA; Marysville, WA; Monroe, WA; Oak Harbor, WA; Snohomish, WA; Anacortes, WA; Arlington, WA…
O20171121000249 WA Part B Supplier - Independent Diagnostic Testing Facility (Idtf) 7517870314 Practice locations: Everett, WA

Other NPIs with the same Medicare PAC ID 6

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

Other NPIs on the same Medicare enrollment 32

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

View all 32

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
50D2234136Western Washington Medical Group3822 Colby Ave Ste 100, Everett, WA 98201Certificate of waiverApr 4, 2028

National Provider Directory

National Provider Directory
Tax ID family
W Wa Med GRP -Dept of a21 organizations share this tax ID, including this one

Other organizations with this tax ID 20

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

View all 20

Locations

1630 Grove St
Marysville, WA 98270
Phone (360) 653-3500

Practitioners & affiliated clinicians

Practitioners 37

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 37

NPI Registry JSON

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

{
    "created_epoch": "1468281600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1499644800000",
    "number": "1720430903",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1728 W MARINE VIEW DR",
            "address_2": "SUITE 110",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982012094",
            "telephone_number": "425-259-4041"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3822 COLBY AVE",
            "address_2": "SUITE 100",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982014913",
            "telephone_number": "425-259-4041"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WESTERN WASHINGTON MEDICAL GROUP, INC PS",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-07-12",
        "last_updated": "2017-07-10",
        "status": "A",
        "authorized_official_last_name": "HOLSTEIN",
        "authorized_official_first_name": "KIM",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "425-259-4041"
    },
    "taxonomies": [
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WWMG Dept of Imaging",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Everett, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2017; 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.