NPIMap

Organization Active NPI

Proliance Surgeons, Inc., P.S.

  • Ambulatory Surgical Clinic/Center
  • Kirkland, WA
National Provider Identifier
1790724862
Registry record updated May 28, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
601484763 Issued in WA
Legal business name
PROLIANCE SURGEONS, INC., P.S.
Practice address
12911 120TH Ave NE Ste H110
Kirkland, WA 98034-3061
Phone
(425) 216-7000
Fax
(425) 216-7019
NPI assigned
Jun 5, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 28, 2021

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

Authorized official

Name
Mrs. Laura Kleisle
Title
Chief Risk Officer
Phone
(206) 838-2590

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X 601484763 WA Primary

Addresses

Primary practice location

12911 120TH Ave NE Ste H110
Kirkland, WA 98034-3061

Mailing address

12911 120TH Ave NE Ste G10
Kirkland, WA 98034-3048

Other identifiers 2

IdentifierTypeStateIssuer
173398OtherWA LABOR & INDUSTRIES
1045664MedicaidWA

Other names 1

  • Proliance Eastside Surgery Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031119000128 WA Part B Supplier - Clinic/Group Practice 8527972900 Receives reassigned benefits from 781 practitioners
This NPI is an additional NPI on the enrollment
O20031208000102 WA Part B Supplier - Ambulatory Surgical Center 8527972900 14 other NPIs on this enrollment
Practice locations: Kirkland, WA

Other NPIs on the same Medicare enrollment 14

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 14

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Proliance Surgeons Inc PSCCN 50C0001218
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
50D1010072Proliance Eastside Surgery Center12911 120TH Ave NE Ste H110, Kirkland, WA 98034Certificate of waiverApr 4, 2028

National Provider Directory

National Provider Directory

Locations

6505 226th Pl SE
Ste 101
Issaquah, WA 98027
Phone (425) 228-6076

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1149465600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1622160000000",
    "number": "1790724862",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12911 120TH AVE NE STE G10",
            "city": "KIRKLAND",
            "state": "WA",
            "postal_code": "980343048"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12911 120TH AVE NE STE H110",
            "city": "KIRKLAND",
            "state": "WA",
            "postal_code": "980343061",
            "telephone_number": "425-216-7000",
            "fax_number": "425-216-7019"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROLIANCE SURGEONS, INC., P.S.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-05",
        "last_updated": "2021-05-28",
        "certification_date": "2021-05-28",
        "status": "A",
        "authorized_official_last_name": "KLEISLE",
        "authorized_official_first_name": "LAURA",
        "authorized_official_title_or_position": "CHIEF RISK OFFICER",
        "authorized_official_telephone_number": "206-838-2590",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "WA",
            "license": "601484763",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WA LABOR & INDUSTRIES",
            "identifier": "173398",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1045664",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Proliance Eastside Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Proliance Eastside Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kirkland, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2021; 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.