NPIMap

Organization Active NPI

Creekside Orthopedics, PLLC

  • Specialist
  • Yakima, WA
National Provider Identifier
1730180746
Registry record updated Aug 16, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
MD0012321 Issued in WA
Legal business name
CREEKSIDE ORTHOPEDICS, PLLC
Practice address
3907 Creekside Loop
Ste. 100
Yakima, WA 98902-4879
Phone
(509) 457-1900
Fax
(509) 853-2700
NPI assigned
Aug 2, 2005
Last updated
Aug 16, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 16, 2011

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

Authorized official

Name
John S Place, MD
Title
Ceo
Phone
(509) 457-1900

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X MD0012321 WA Primary

Addresses

Primary practice location

3907 Creekside Loop
Ste. 100
Yakima, WA 98902-4879

Mailing address

PO Box 8051
Yakima, WA 98908-0051
Phone (509) 469-1903

Other identifiers 2

IdentifierTypeStateIssuer
7126642MedicaidWA
0197897OtherWALABOR AND INDUSTRIES

National Provider Directory

National Provider Directory

Locations

213 S 11th Ave
Yakima, WA 98902
Phone (509) 457-1900

Practitioners & affiliated clinicians

Practitioners 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1122940800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1313452800000",
    "number": "1730180746",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8051",
            "city": "YAKIMA",
            "state": "WA",
            "postal_code": "989080051",
            "telephone_number": "509-469-1903",
            "fax_number": "509-469-1905"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3907 CREEKSIDE LOOP",
            "address_2": "STE. 100",
            "city": "YAKIMA",
            "state": "WA",
            "postal_code": "989024879",
            "telephone_number": "509-457-1900",
            "fax_number": "509-853-2700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CREEKSIDE ORTHOPEDICS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-02",
        "last_updated": "2011-08-16",
        "status": "A",
        "authorized_official_last_name": "PLACE",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "509-457-1900",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "WA",
            "license": "MD0012321",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7126642",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LABOR AND INDUSTRIES",
            "identifier": "0197897",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Yakima, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2011; 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.