Franciscan Medical Group

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

FRANCISCAN MEDICAL GROUP

Doing business as

Lakes Family Medicine-Bonnie Lake

Practice address

8412 Myers Rd E
Ste 203
Bonney Lake, WA 98391-5112

Phone

(253) 863-2587

Fax

(253) 863-2588

NPI assigned

Aug 27, 2007

Last updated

Feb 20, 2008By the provider in NPPES

Organization subpart

Yes

Parent organization

FRANCISCAN MEDICAL GROUPAs reported in NPPES

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

Authorized official

Name

Cliff A. Robertson, MD

Title

President/ Chief Medical Officer

Phone

(253) 779-6101

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Lakes Family Medicine-Bonnie Lake Doing business as

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

Part of

CHI Franciscan Health

Locations

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

{
    "created_epoch": "1188172800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1203465600000",
    "number": "1841483450",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8412 MYERS RD E",
            "address_2": "STE 203",
            "city": "BONNEY LAKE",
            "state": "WA",
            "postal_code": "983915112",
            "telephone_number": "253-863-2587",
            "fax_number": "253-863-2588"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8412 MYERS RD E",
            "address_2": "STE 203",
            "city": "BONNEY LAKE",
            "state": "WA",
            "postal_code": "983915112",
            "telephone_number": "253-863-2587",
            "fax_number": "253-863-2588"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FRANCISCAN MEDICAL GROUP",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FRANCISCAN MEDICAL GROUP",
        "enumeration_date": "2007-08-27",
        "last_updated": "2008-02-20",
        "status": "A",
        "authorized_official_last_name": "ROBERTSON",
        "authorized_official_first_name": "CLIFF",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "PRESIDENT/ CHIEF MEDICAL OFFICER",
        "authorized_official_telephone_number": "253-779-6101",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7139181",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE L&I",
            "identifier": "0224335",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lakes Family Medicine-Bonnie Lake",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Michelle Marie Fodczuk
• Christa Diane Fonda, RD, CDR
• Paula A Foster, LMP
• Franciscan Health System (Franciscan Bonney Lake)
• Franciscan Medical Group (Franciscan Medical Clinic-Bonney Lake)
• Fred Meyer Stores Inc (Fred Meyer Pharmacy)
• Freedom Recovery Center LLC
• Addison Taylor Freitag, DPT
• Fresh Start Counseling PLLC
• Isaac C Fu, DDS,MSD

• Family Medicine Physician in Bonney Lake, WA
• Providers in Bonney Lake, WA by specialty
• Family Medicine Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2008; 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.