NPIMap

Organization Active NPI

Pediatric Associates of Whidbey Island, PS

  • Pediatrics Physician
  • Oak Harbor, WA
National Provider Identifier
1770700072
Registry record updated Sep 27, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
PEDIATRIC ASSOCIATES OF WHIDBEY ISLAND, PS
Practice address
275 SE Cabot Dr
Suite B102
Oak Harbor, WA 98277-3715
Phone
(360) 675-5555
Fax
(360) 675-0275
NPI assigned
Apr 19, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 27, 2017

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

Authorized official

Name
Molly S Nagel
Title
Office Manager
Phone
(360) 675-5555

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X Primary
Rural Health Clinic/Center 261QR1300X WA

Addresses

Primary practice location

275 SE Cabot Dr
Suite B102
Oak Harbor, WA 98277-3715

Mailing address

275 SE Cabot Dr
Suite B102
Oak Harbor, WA 98277-3715
Phone (360) 675-5555

Other identifiers 1

IdentifierTypeStateIssuer
1045623MedicaidWA

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
50D0858569Pediatric Associates of Whidbey Island PS275 SE Cabot Dr Suite B102, Oak Harbor, WA 98277Provider-performed microscopyApr 4, 2028

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 16

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

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1176940800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1506470400000",
    "number": "1770700072",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "275 SE CABOT DR",
            "address_2": "SUITE B102",
            "city": "OAK HARBOR",
            "state": "WA",
            "postal_code": "982773715",
            "telephone_number": "360-675-5555",
            "fax_number": "360-675-0275"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "275 SE CABOT DR",
            "address_2": "SUITE B102",
            "city": "OAK HARBOR",
            "state": "WA",
            "postal_code": "982773715",
            "telephone_number": "360-675-5555",
            "fax_number": "360-675-0275"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC ASSOCIATES OF WHIDBEY ISLAND, PS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-19",
        "last_updated": "2017-09-27",
        "status": "A",
        "authorized_official_last_name": "NAGEL",
        "authorized_official_first_name": "MOLLY",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "360-675-5555"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "WA",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1045623",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Oak Harbor, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.