NPIMap

Organization Active NPI

Pacific Vascular Incorporated

  • Physiological Laboratory
  • Yakima, WA
National Provider Identifier
1831245836
Registry record updated Dec 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physiological LaboratoryTaxonomy code 293D00000X
Legal business name
PACIFIC VASCULAR INCORPORATED
Practice address
3902 Creekside Loop
Suite 105
Yakima, WA 98902-4876
Phone
(509) 249-5735
Fax
(425) 486-8976
NPI assigned
Jan 25, 2007
Organization subpart
Yes
Parent organization
PACIFIC VASCULAR INCORPORATEDAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 2, 2025

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

Authorized official

Name
Bonnie M Brown, RVT
Title
Ceo
Phone
(425) 398-7781

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physiological Laboratory 293D00000X Primary

Addresses

Primary practice location

3902 Creekside Loop
Suite 105
Yakima, WA 98902-4876

Mailing address

11714 N Creek Pkwy N Ste 100
Bothell, WA 98011-8250
Phone (425) 486-8868

Other identifiers 2

IdentifierTypeStateIssuer
7015852MedicaidWA
P00219638OtherWARAILROAD MEDICARE

Other names 1

  • Pacific Vascular-Yakima Creekside Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040617000453 WA Part B Supplier - Independent Diagnostic Testing Facility (Idtf) 9739073388 Practice locations: Yakima, WA

Other NPIs with the same Medicare PAC ID 13

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

View all 13

National Provider Directory

National Provider Directory
Tax ID family
Pacific Vascular Incor15 organizations share this tax ID, including this one
Part of
Pacific Vascular Incor

Other organizations with this tax ID 14

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

View all 14

Practitioners & affiliated clinicians

Practitioners 16

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

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1169683200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1764633600000",
    "number": "1831245836",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11714 N CREEK PKWY N STE 100",
            "city": "BOTHELL",
            "state": "WA",
            "postal_code": "980118250",
            "telephone_number": "425-486-8868",
            "fax_number": "425-486-8976"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3902 CREEKSIDE LOOP",
            "address_2": "SUITE 105",
            "city": "YAKIMA",
            "state": "WA",
            "postal_code": "989024876",
            "telephone_number": "509-249-5735",
            "fax_number": "425-486-8976"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFIC VASCULAR INCORPORATED",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PACIFIC VASCULAR INCORPORATED",
        "enumeration_date": "2007-01-25",
        "last_updated": "2025-12-02",
        "certification_date": "2025-12-02",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "BONNIE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "425-398-7781",
        "authorized_official_credential": "RVT"
    },
    "taxonomies": [
        {
            "code": "293D00000X",
            "taxonomy_group": "",
            "desc": "Physiological Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7015852",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00219638",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pacific Vascular-Yakima Creekside",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Pacific Vascular-Yakima Creekside",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Yakima, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2025; 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.