NPIMap

Individual provider Active NPI

Christoph Michael Prummer, M.D.

  • Otolaryngology Physician
  • Puyallup, WA
National Provider Identifier
1740660638
Registry record updated Dec 10, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
MD61039326 Issued in WA
Practice address
104 27TH Ave SE
Puyallup, WA 98374-1145
Phone
(253) 770-9000
Fax
(253) 770-9712
NPI assigned
Jun 4, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 10, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X MD61039326 WA Primary

Addresses

Primary practice location

104 27TH Ave SE
Puyallup, WA 98374-1145

Mailing address

PO Box 1205
Puyallup, WA 98371-0231
Phone (253) 770-9000

Other identifiers 2

IdentifierTypeStateIssuer
2158054MedicaidWA
440476OtherWAWA LABOR & INDUSTRIES

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200728002714 WA Practitioner - Otolaryngology 8921319674 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
University of Washington School of Medicine, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Proliance Surgeons Inc P SGroup PAC ID 8527972900, 395 clinicians

Practice addresses (Care Compare)

104 27TH Ave SE
Puyallup, WA 98374-1145
Phone (253) 770-9000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Proliance Surgeons Inc P S Current Accepting new patients
Proliance Surgeons Inc PS CurrentSince Dec 12, 2021 Accepting new patients
Proliance Surgeons, Inc., P.S. CurrentSince Sep 20, 2021 Accepting new patients
Proliance Surgeons Inc P S CurrentSince Sep 20, 2021 Accepting new patients
The Vancouver Clinic Inc PS CurrentSince Aug 24, 2020 Accepting new patients
The Vancouver Clinic Inc PS Otolaryngology CurrentSince Aug 24, 2020 Accepting new patients
Proliance Surgeons, Inc., P.S. Otolaryngology PastSince Dec 12, 2021 Accepting new patients
Proliance Surgeons Inc., P.S. Past Accepting new patients

Locations

104 27th Ave SE
Puyallup, WA 98374
Phone (253) 770-4099

3801 5th St SE
Ste 110
Puyallup, WA 98374
Phone (253) 845-9585

805 Madison St
Ste 901
Seattle, WA 98104
Phone (206) 264-8100

501 SE 172nd Ave
Vancouver, WA 98684

2525 NE 139th St
Ste 220
Vancouver, WA 98686
Phone (360) 397-4437

2525 NE 139th St
Vancouver, WA 98686
Phone (360) 397-1500

700 NE 87th Ave
Vancouver, WA 98664
Phone (360) 397-1500

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1433376000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639094400000",
    "number": "1740660638",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1205",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983710231",
            "telephone_number": "253-770-9000",
            "fax_number": "253-770-9712"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 27TH AVE SE",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983741145",
            "telephone_number": "253-770-9000",
            "fax_number": "253-770-9712"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRUMMER",
        "first_name": "CHRISTOPH",
        "middle_name": "MICHAEL",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-06-04",
        "last_updated": "2021-12-10",
        "certification_date": "2021-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "WA",
            "license": "MD61039326",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2158054",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WA LABOR & INDUSTRIES",
            "identifier": "440476",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Puyallup, WA

Sources for this page

Verify at the official NPI Registry.