Proliance Surgeons, Inc., P.S.

Primary specialty

Otolaryngology PhysicianTaxonomy code 207Y00000X

License

601484763 Issued in WA

Legal business name

PROLIANCE SURGEONS, INC., P.S.

Doing business as

Proliance Surgeons Puget Sound ENT

Practice address

21911 76TH Ave W Ste 211
Edmonds, WA 98026-7918

Phone

(425) 775-6651

Fax

(425) 670-6718

NPI assigned

Nov 23, 2007

Last updated

Nov 1, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Cori M. Pleasant

Title

MGR Provider Relations/Enrollment

Phone

(206) 838-2585

Specialties & licenses 4

Addresses

Other names 1

• Proliance Surgeons Puget Sound ENT Doing business as

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

Locations

Practitioners 11

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.

• Leah Joyce Alvis, AUD, CCC-A

  • Audiologist
  • Edmonds, WA
  • NPI 1922030097
  NPD
• Matthew Bartindale, M.D.

  • Otolaryngology Physician
  • Edmonds, WA
  • NPI 1033539721
  NPD
• Laura Elizabeth Jackson, PA-C

  • Surgical Physician Assistant
  • Seattle, WA
  • NPI 1780206060
  NPD
• Tyler Graham Kimbrough, MD

  • Otolaryngology Physician
  • Edmonds, WA
  • NPI 1720121361
  NPD
• Erin Elizabeth Lazar, AU.D.

  • Audiologist
  • Seattle, WA
  • NPI 1699178426
  NPD
• Daniel Junho Lee, MD

  • Otolaryngology Physician
  • Edmonds, WA
  • NPI 1336646066
  NPD
• Lisa Marie Mulligan, M.D.

  • Otolaryngology Physician
  • Edmonds, WA
  • NPI 1093891103
  NPD
• Duncan A Riddell, M.D.

  • Otolaryngology Physician
  • Edmonds, WA
  • NPI 1801993829
  NPD
• Jeffrey M Singh, D.O.

  • Otolaryngology Physician
  • Edmonds, WA
  • NPI 1316327992
  NPD
• Alex Joseph Fejta Tampio, M.D.

  • Otolaryngology Physician
  • Tacoma, WA
  • NPI 1912351289
  NPD
• Michael J Young, PA

  • Surgical Physician Assistant
  • Bellevue, WA
  • NPI 1225181902
  NPD

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

{
    "created_epoch": "1195776000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1667260800000",
    "number": "1770764342",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21911 76TH AVE W STE 211",
            "city": "EDMONDS",
            "state": "WA",
            "postal_code": "980267918",
            "telephone_number": "425-775-6651"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21911 76TH AVE W STE 211",
            "city": "EDMONDS",
            "state": "WA",
            "postal_code": "980267918",
            "telephone_number": "425-775-6651",
            "fax_number": "425-670-6718"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "104 27th Ave SE",
            "address_purpose": "LOCATION",
            "city": "Puyallup",
            "state": "WA",
            "postal_code": "983741145",
            "country_code": "US",
            "telephone_number": "425-775-6651",
            "fax_number": "425-670-6718",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "13020 Meridian Ave S Fl 2",
            "address_purpose": "LOCATION",
            "city": "Everett",
            "state": "WA",
            "postal_code": "982086468",
            "country_code": "US",
            "telephone_number": "425-775-6651",
            "fax_number": "425-670-6718",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "515 Minor Ave Ste 140",
            "address_purpose": "LOCATION",
            "city": "Seattle",
            "state": "WA",
            "postal_code": "981042138",
            "country_code": "US",
            "telephone_number": "425-775-6651",
            "fax_number": "425-670-6718",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "515 Minor Ave Ste 150",
            "address_purpose": "LOCATION",
            "city": "Seattle",
            "state": "WA",
            "postal_code": "981042144",
            "country_code": "US",
            "telephone_number": "425-775-6651",
            "fax_number": "425-670-6718",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PROLIANCE SURGEONS, INC., P.S.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-23",
        "last_updated": "2022-11-01",
        "certification_date": "2022-11-01",
        "status": "A",
        "authorized_official_last_name": "PLEASANT",
        "authorized_official_first_name": "CORI",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "MGR PROVIDER RELATIONS/ENROLLMENT",
        "authorized_official_telephone_number": "206-838-2585"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Otolaryngology",
            "state": "WA",
            "license": "601484763",
            "primary": true
        },
        {
            "code": "207YX0901X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Otolaryngology, Otology & Neurotology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "231H00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Audiologist",
            "state": "WA",
            "license": "601484763",
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Proliance Surgeons Puget Sound ENT",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Proliance Surgeons Inc P S (Proliance Edmonds Center for Outpatient Surgery)
• Proliance Surgeons Inc., P.S. (Proliance Surgical Specialists of Edmonds)
• Proliance Surgeons Inc., P.S. (Proliance Northwest Pain Management Associates)
• Proliance Surgeons Inc., P.S. (Proliance Physical & Hand Therapy)
• Proliance Surgeons, Inc., P.S (Proliance Surgeons Ankle and Foot of Edmonds)
• Martin Proudfoot, M.D.
• Psychiatry Evergreen PLLC
• Public Hosp Dist 2 of Snoh County (Stevens Healthcare)
• Public Hosp District #2 of Snoh County (Center for Wound Healing & Hyperbarics)
• Public Hospital District #2 of Snohomish County (Stevens Healthcare Services)

• Otolaryngology Physician in Edmonds, WA
• Providers in Edmonds, WA by specialty
• Otolaryngology Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.