Praveen Kumar Mambalam, M.D.

Primary specialty

Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X

License

MD 00049423 Issued in WA

Practice address

21616 76TH Ave W
Ste 102
Edmonds, WA 98026-7512

Phone

(425) 774-1538

Fax

(425) 744-1527

NPI assigned

May 17, 2008

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WA, OR, FL, MD, DC5 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 5

Specialty

Anesthesiology

Education

Other, 2004

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Pain and Spine Specialists of Maryland LLCGroup PAC ID 2668628124, 32 clinicians

Washington Pain and Spine Specialists LLCGroup PAC ID 7315381639, 3 clinicians

Pain Care Physicians PLLCGroup PAC ID 9537448931, 13 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Providence St Peter Hospital Hospital, Olympia, WA, CCN 500024
• Providence Centralia Hospital Hospital, Centralia, WA, CCN 500019
• Grays Harbor Community Hospital Hospital, Aberdeen, WA, CCN 500031

Merit-based Incentive Payment System (MIPS)

Final score

93.88 of 100Reported as group

Quality

100

Improvement activities

40

Cost

64.49

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations (25 of 26)

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/11878/brand/3/csg/1/fhir/r4
• Direct secure messaging: praveen.mambalam.1@11878.direct.athenahealth.com
• Direct secure messaging: praveen.mambalam.2@11878.direct.athenahealth.com
• FHIR API: https://fhir4.healow.com/fhir/r4/IJBDDD
• FHIR API: https://api.platform.athenahealth.com/11878/brand/11/csg/1/fhir/r4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Washington Pain and Spine Specialists LLC

  • Pain Clinic/Center
  • Olympia, WA
  • NPI 1992486906
  Medicare reassignment Care Compare group NPD Authorized official
• Pain Care Physicians PLLC

  • Interventional Pain Medicine Physician
  • Renton, WA
  • NPI 1144779232
  Medicare reassignment Care Compare group NPD
• Pain and Spine Specialists of Maryland, LLC

  • Specialist
  • Mount Airy, MD
  • NPI 1174884258

  DC, FL, Pain Medicine

  Medicare reassignment Care Compare group NPD
• Washington Center for Pain Management LLC

  • Clinic/Center
  • Puyallup, WA
  • NPI 1194381905
  Medicare reassignment NPD
• Elkridge ASC LLC

  • Ambulatory Surgical Clinic/Center
  • Elkridge, MD
  • NPI 1487169769
  Medicare reassignment NPD
• Progressive Rehabilitation Associates LLC

  • Clinic/Center
  • Portland, OR
  • NPI 1790760908
  Medicare reassignment NPD
• Simcare ASC LLC

  • Ambulatory Surgical Clinic/Center
  • Mount Airy, MD
  • NPI 1538427943
  Medicare reassignment NPD
• Washington Pain and Spine Specialists LLC

  • Durable Medical Equipment & Medical Supplies
  • Everett, WA
  • NPI 1437082013
  NPD Authorized official
• Pain Care Physicians PLLC

  • Ambulatory Surgical Clinic/Center
  • Olympia, WA
  • NPI 1619530839
  NPD
• Sports and Spine

  • Clinic/Center
  • Bellevue, WA
  • NPI 1598255903
  NPD
• Washington Center for Pain Management, LLC

  • Interventional Pain Medicine Physician
  • Olympia, WA
  • NPI 1871260760
  NPD
• Sound Medical Imaging PLLC

  • Diagnostic Radiology Physician
  • Puyallup, WA
  • NPI 1598713273
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Grays Harbor Community Hospital

  • General Acute Care Hospital
  • Aberdeen, WA
  • NPI 1154378859
  Care Compare affiliation
• Providence Health & Services Washington

  • General Acute Care Hospital
  • Olympia, WA
  • NPI 1346250594
  Care Compare affiliation
• Providence Health & Services Washington

  • General Acute Care Hospital
  • Centralia, WA
  • NPI 1376624981
  Care Compare affiliation
• Providence Health & Services Washington

  • General Acute Care Hospital
  • Olympia, WA
  • NPI 1619176997
  Care Compare affiliation

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

{
    "created_epoch": "1210982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684800000000",
    "number": "1790942886",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 827",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980090827",
            "telephone_number": "425-774-1538",
            "fax_number": "425-744-1527"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21616 76TH AVE W",
            "address_2": "STE 102",
            "city": "EDMONDS",
            "state": "WA",
            "postal_code": "980267512",
            "telephone_number": "425-774-1538",
            "fax_number": "425-744-1527"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "155 Lilly Rd NE Ste B",
            "address_purpose": "LOCATION",
            "city": "Olympia",
            "state": "WA",
            "postal_code": "985065028",
            "country_code": "US",
            "telephone_number": "206-538-6300",
            "fax_number": "206-538-6301",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MAMBALAM",
        "first_name": "PRAVEEN",
        "middle_name": "KUMAR",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-05-17",
        "last_updated": "2023-05-23",
        "certification_date": "2023-05-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "WA",
            "license": "MD 00049423",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Roderick K Mahurin, PH.D.
• Mai Pham, MD PS
• John D Maldazys, MD
• Gurjot Kaur Malhi, MD
• Linda Mallery, LPN
• Carolyn Elizabeth Mangelsdorf, PH.D.
• Terra Rose Mangum, MN, ARNP
• Carolyn P Maret, LICSW
• Mary Margaret, L.M.P.
• Ashlee Marie Margheim, MD

• Pain Medicine (Anesthesiology) Physician in Edmonds, WA
• Providers in Edmonds, WA by specialty
• Pain Medicine (Anesthesiology) Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.