Franciscan Medical Group
Organization Active NPI Family Medicine Physician · Enumclaw, WA
NPI 1801825641 · NPPES record last updated Jul 2, 2012
Key facts
- NPI
- 1801825641
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- FRANCISCAN MEDICAL GROUP
- Practice address
- 3021 Griffin Ave
Enumclaw, WA 98022-2369 - Phone
- (360) 825-6511
- NPI assigned
- Jul 2, 2006
- Organization subpart
- Yes
- Parent organization (as reported)
- FRANCISCAN MEDICAL GROUP
Authorized official
- Name
- Cliff Robertson
- Title
- Chief Medical Officer
- Phone
- (253) 779-6101
Other NPIs with the same Medicare PAC ID 5
Practitioners 1,400
-
Naseer Abbas, MD
-
Hasan Abdessamad, MD
-
Omar Abdul-Hadi, MD
-
Fauzia Ashley Abilmona, M.D.
-
Brenda Lee Abraham, N.P.
-
Sujeen Adhikari, D.O.
-
Christopher John Adrig, PA-C
-
Manoj Agarwal, MD, MBA
-
Vivek Agarwal, M.D.
-
Giovanni Aggabao, ARNP
-
Mudassar Raees Ahmad, MB,BS
-
Katayoun Akbari, PAC
-
Oviea Akpotaire, MD
-
Jordan Albano, PA-C
-
Jeffrey Grande Albores, M.D.
-
Charene S. Alderman, ARNP
-
Robera Aman Aleye, ARNP
-
Fizzah M Ali, M.D.
-
Nidal Almasri, DMSC, PA-C
-
Eric Gordon Alyea, D.O., M.P.H.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 50D0633400 | Franciscan Medical Clinic - Enumclaw | Certificate of waiver | Apr 4, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in WA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031111000789 | WA | Part B Supplier - Clinic/Group Practice | 0547173866 |
Receives reassigned benefits from 1,720 practitioners This NPI is an additional NPI on the enrollment |
| O20100930028341 | WA | DME Supplier - Multi-Specialty - Physician | 0547173866 | Practice locations: Enumclaw, WA |
National Provider Directory
- Part of
- Enumclaw Medical Center
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes | ||
| Obstetrics & Gynecology Physician |
207V00000X | |||
| Surgery Physician |
208600000X |
Addresses
Primary practice location
3021 Griffin Ave
Enumclaw, WA 98022-2369
Mailing address
3021 Griffin Ave
Enumclaw, WA 98022-2369
Phone (360) 825-6511
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7093776 | Medicaid | WA | |
| 0126687 | Other | WA | STATE L&I |
| 7131584 | Medicaid | WA |
Other names
- Franciscan Medical Clinic-Enumclaw
Other providers in Enumclaw, WA
- Larissa Francis
- Franciscan Medical Group
- Franciscan Medical Group
- Franciscan Medical Group
- Franciscan Medical Group
- Franciscan Medical Group
- Fred Meyer Stores Inc
- Luther A Frerichs
- Joy Yea Frey
- Friendship House
All providers in Enumclaw, WA · Family Medicine Physician in Washington
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 2, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.