NPIMap

Organization Active NPI

Pacifica Medicine

  • Family Medicine Physician
  • Poulsbo, WA
National Provider Identifier
1831563600
Registry record updated Jul 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
PACIFICA MEDICINE
Practice address
19036 Front St NE # 100
Poulsbo, WA 98370-7354
Phone
(360) 979-0569
Fax
(877) 805-9505
NPI assigned
Nov 17, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 27, 2024

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

Authorized official

Name
Dr. Marie Matty, MDNPI 1740224880
Title
Owner
Phone
(360) 297-8805

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207Q00000X WA Primary

Addresses

Primary practice location

19036 Front St NE # 100
Poulsbo, WA 98370-7354

Mailing address

PO Box 2940
Poulsbo, WA 98370-2940
Phone (360) 297-8805

Other practice location 1

1173 Madison Ave N
Bainbridge Island, WA 98110-1782
Phone (360) 979-0569

Other identifiers 2

IdentifierTypeStateIssuer
1871543900OtherWANPI
1740224880OtherWANPI

Other names 1

  • CHYMIYMATTYMDLLC Other name

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
50D2255985Pacifica Medicine & Wellness1173 Madison Ave N, Bainbridge Island, WA 98110Certificate of waiverApr 4, 2028

National Provider Directory

National Provider Directory
Tax ID family
Chymiymattymd LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

19036 Front St NE
#100
Poulsbo, WA 98370
Phone (360) 979-0569

19980 10th Ave NE
Ste 202
Poulsbo, WA 98370
Phone (360) 979-0569

Practitioners & affiliated clinicians

Practitioners 9

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

NPI Registry JSON

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

{
    "created_epoch": "1447718400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722038400000",
    "number": "1831563600",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2940",
            "city": "POULSBO",
            "state": "WA",
            "postal_code": "983702940",
            "telephone_number": "360-297-8805",
            "fax_number": "360-297-1676"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19036 FRONT ST NE # 100",
            "city": "POULSBO",
            "state": "WA",
            "postal_code": "983707354",
            "telephone_number": "360-979-0569",
            "fax_number": "877-805-9505"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1173 Madison Ave N",
            "address_purpose": "LOCATION",
            "city": "Bainbridge Island",
            "state": "WA",
            "postal_code": "981101782",
            "country_code": "US",
            "telephone_number": "360-979-0569",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PACIFICA MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-11-17",
        "last_updated": "2024-07-27",
        "certification_date": "2024-07-27",
        "status": "A",
        "authorized_official_last_name": "MATTY",
        "authorized_official_first_name": "MARIE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "360-297-8805",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "WA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1871543900",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1740224880",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CHYMIYMATTYMDLLC",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "CHYMIYMATTYMDLLC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Poulsbo, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.