NPIMap

Organization Active NPI

Optum Care Washington PLLC

  • Durable Medical Equipment & Medical Supplies
  • Mill Creek, WA
National Provider Identifier
1801946579
Registry record updated Apr 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
OPTUM CARE WASHINGTON PLLC
Practice address
15418 Main St
Mill Creek, WA 98012-9030
Phone
(425) 225-8000
NPI assigned
Jan 12, 2007
Last updated
Apr 11, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
EVERETT PHYSICIANS, INC. P.S.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 11, 2024

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

Authorized official

Name
Dr. George Go, MD
Title
Board President
Phone
(425) 259-0966

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X 50D1060436 WA
Durable Medical Equipment & Medical Supplies 332B00000X NU Primary

Addresses

Primary practice location

15418 Main St
Mill Creek, WA 98012-9030

Mailing address

PO Box 5127
Everett, WA 98206-5127
Phone (425) 225-8000

Other identifiers 2

IdentifierTypeStateIssuer
33000OtherWAL&I
7776503MedicaidWA

Other names 1

  • Optum - Mill Creek Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100930097679 WA DME Supplier - Physician - Podiatry 6406752153 Practice locations: Mill Creek, WA

Other NPIs with the same Medicare PAC ID 19

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 19

National Provider Directory

National Provider Directory
Tax ID family
Everett Clinic30 organizations share this tax ID, including this one

Other organizations with this tax ID 29

Organizations that report the same tax identification number in the National Provider Directory.

View all 29

Locations

15418 Main St
Mill Creek, WA 98012
Phone (425) 225-8000

NPI Registry JSON

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

{
    "created_epoch": "1168560000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712793600000",
    "number": "1801946579",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5127",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982065127",
            "telephone_number": "425-225-8000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15418 MAIN ST",
            "city": "MILL CREEK",
            "state": "WA",
            "postal_code": "980129030",
            "telephone_number": "425-225-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTUM CARE WASHINGTON PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EVERETT PHYSICIANS, INC. P.S.",
        "enumeration_date": "2007-01-12",
        "last_updated": "2024-04-11",
        "certification_date": "2024-04-11",
        "status": "A",
        "authorized_official_last_name": "GO",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_title_or_position": "BOARD PRESIDENT",
        "authorized_official_telephone_number": "425-259-0966",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "WA",
            "license": "50D1060436",
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "L&I",
            "identifier": "33000",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7776503",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Optum - Mill Creek",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Mill Creek, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2024; 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.