NPIMap

Organization Active NPI

Eastside Medical Group, LLC

  • Ambulatory Surgical Clinic/Center
  • Issaquah, WA
National Provider Identifier
1750709358
Registry record updated Jan 18, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
Legal business name
EASTSIDE MEDICAL GROUP, LLC
Practice address
1301 4TH Ave NW
Issaquah, WA 98027-9371
Phone
(425) 270-3713
Fax
(425) 295-7557
NPI assigned
Apr 1, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 18, 2017

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

Authorized official

Name
Robert Howie
Title
Treasurer
Phone
(425) 837-9720

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X Primary
Multi-Specialty Clinic/Center 261QM1300X

Addresses

Primary practice location

1301 4TH Ave NW
Issaquah, WA 98027-9371

Mailing address

1301 4TH Ave NW
Suite 201
Issaquah, WA 98027-9371
Phone (425) 270-3713

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140512000378 WA Part B Supplier - Ambulatory Surgical Center 3870726185 Practice locations: Issaquah, WA

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Eastside Medical Group LLCCCN 50C0001306
Medicare certification status
ActiveFrom the Provider of Services file

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
50D2078838Eastside Medical Group1301 4TH Ave NW Ste 201, Issaquah, WA 98027Certificate of waiverApr 4, 2028

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 20

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

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1396310400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1484697600000",
    "number": "1750709358",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1301 4TH AVE NW",
            "address_2": "SUITE 201",
            "city": "ISSAQUAH",
            "state": "WA",
            "postal_code": "980279371",
            "telephone_number": "425-270-3713",
            "fax_number": "425-295-7557"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1301 4TH AVE NW",
            "city": "ISSAQUAH",
            "state": "WA",
            "postal_code": "980279371",
            "telephone_number": "425-270-3713",
            "fax_number": "425-295-7557"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTSIDE MEDICAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-01",
        "last_updated": "2017-01-18",
        "status": "A",
        "authorized_official_last_name": "HOWIE",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "TREASURER",
        "authorized_official_telephone_number": "425-837-9720"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Issaquah, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 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.