NPIMap

Organization Active NPI

Western Washington Medical Group, Inc PS

Doing business as WWMG - Pathology

  • Histology Specialist/Technologist
  • Everett, WA
National Provider Identifier
1831238443
Registry record updated Aug 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Histology Specialist/TechnologistTaxonomy code 246QH0600X
Legal business name
WESTERN WASHINGTON MEDICAL GROUP, INC PS
Doing business as
WWMG - Pathology
Practice address
4225 Hoyt Ave Ste a
Everett, WA 98203-2351
Phone
(425) 259-3122
Fax
(425) 252-9860
NPI assigned
Feb 6, 2007
Last updated
Aug 4, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
WESTERN WASHINGTON MEDICAL GROUPAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 4, 2023

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

Authorized official

Name
Amelia Edens
Title
Director of Patient Financial SVCS
Phone
(425) 740-4142

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Histology Specialist/TechnologistGroup: 193200000X MULTI-SPECIALTY GROUP 246QH0600X Primary

Addresses

Primary practice location

4225 Hoyt Ave Ste a
Everett, WA 98203-2351

Mailing address

1728 W Marine View Dr Ste 110
Everett, WA 98201-2094
Phone (425) 259-3122

Other identifiers 2

IdentifierTypeStateIssuer
601474013OtherWABUSINESS LICENSE
7137474MedicaidWA

Other names 1

  • WWMG - Pathology Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070815000595 WA Part B Supplier - Slide Preparation Facilities 7517870314 Practice locations: Everett, WA

Other NPIs with the same Medicare PAC ID 6

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

National Provider Directory

National Provider Directory
Tax ID family
Western Wa Medical Group21 organizations share this tax ID, including this one
Part of
Western Wa Medical Group

Other organizations with this tax ID 20

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

View all 20

Locations

4225 Hoyt Ave
Ste A
Everett, WA 98203
Phone (425) 259-3122

NPI Registry JSON

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

{
    "created_epoch": "1170720000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1691107200000",
    "number": "1831238443",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1728 W MARINE VIEW DR STE 110",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982012094",
            "telephone_number": "425-259-3122",
            "fax_number": "425-252-9860"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4225 HOYT AVE STE A",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982032351",
            "telephone_number": "425-259-3122",
            "fax_number": "425-252-9860"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WESTERN WASHINGTON MEDICAL GROUP, INC PS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WESTERN WASHINGTON MEDICAL GROUP",
        "enumeration_date": "2007-02-06",
        "last_updated": "2023-08-04",
        "certification_date": "2023-08-04",
        "status": "A",
        "authorized_official_last_name": "EDENS",
        "authorized_official_first_name": "AMELIA",
        "authorized_official_title_or_position": "DIRECTOR OF PATIENT FINANCIAL SVCS",
        "authorized_official_telephone_number": "425-740-4142"
    },
    "taxonomies": [
        {
            "code": "246QH0600X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist/Technologist, Pathology, Histology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BUSINESS LICENSE",
            "identifier": "601474013",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7137474",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WWMG - Pathology",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "WWMG - Pathology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Everett, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2023; 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.