NPIMap

Organization Active NPI

Creekside Medical, PS

  • Internal Medicine Physician
  • Vancouver, WA
National Provider Identifier
1760529374
Registry record updated Feb 9, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
CREEKSIDE MEDICAL, PS
Practice address
900 NE 139TH St
Suite 202
Vancouver, WA 98685-2513
Phone
(360) 566-9355
Fax
(360) 816-1327
NPI assigned
Jan 31, 2007
Last updated
Feb 9, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 9, 2026

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

Authorized official

Name
Mrs. Michelle L Vincent
Title
Practice Administrator
Phone
(360) 566-9355

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X WA
Internal Medicine Physician 207R00000X WA Primary
Pediatrics Physician 208000000X WA

Addresses

Primary practice location

900 NE 139TH St
Suite 202
Vancouver, WA 98685-2513

Mailing address

900 NE 139TH St
Suite 202
Vancouver, WA 98685-2513
Phone (360) 566-9355

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041001000718 WA Part B Supplier - Clinic/Group Practice 4082683388 Receives reassigned benefits from 12 practitioners
Practice locations: Vancouver, WA

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
50D1031109Creekside Medical900 NE 139TH St Ste 202, Vancouver, WA 98685Certificate of waiverApr 4, 2028

National Provider Directory

National Provider Directory

Locations

900 NE 139th St
Ste 202
Vancouver, WA 98685
Phone (360) 566-9355

Practitioners & affiliated clinicians

Practitioners 12

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": "1170201600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1770595200000",
    "number": "1760529374",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 NE 139TH ST",
            "address_2": "SUITE 202",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986852513",
            "telephone_number": "360-566-9355",
            "fax_number": "360-816-1327"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 NE 139TH ST",
            "address_2": "SUITE 202",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986852513",
            "telephone_number": "360-566-9355",
            "fax_number": "360-816-1327"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CREEKSIDE MEDICAL, PS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-31",
        "last_updated": "2026-02-09",
        "certification_date": "2026-02-09",
        "status": "A",
        "authorized_official_last_name": "VINCENT",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "360-566-9355",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "WA",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WA",
            "license": null,
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "WA",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vancouver, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2026; 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.