Proliance Surgeons, Inc., P.S.

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

601484763 Issued in WA

Legal business name

PROLIANCE SURGEONS, INC., P.S.

Doing business as

Proliance Retina

Practice address

1750 112TH Ave NE Ste D050
Bellevue, WA 98004

Phone

(206) 215-3850

Fax

(206) 215-3870

NPI assigned

Dec 5, 2011

Last updated

May 28, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Laura Kleisle

Title

Chief Risk Officer

Phone

(206) 838-2590

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• Proliance Retina Doing business as

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

Locations

Practitioners 27

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Andrew Samuel Barloon, MD

  • Ophthalmology Physician
  • Bellevue, WA
  • NPI 1457350670
  NPD
• Charles D Birnbach, M.D.

  • Ophthalmology Physician
  • Bellevue, WA
  • NPI 1144255936
  NPD
• Yicheng Chen, MD

  • Ophthalmology Physician
  • Kent, WA
  • NPI 1124314653
  NPD
• Melissa Roach Denison, ARNP

  • Acute Care Nurse Practitioner
  • Federal Way, WA
  • NPI 1306130505
  NPD
• Trevor Gatenby, DPM

  • Foot & Ankle Surgery Podiatrist
  • Everett, WA
  • NPI 1649879347
  NPD
• Geordie McGill Glass, PA-C

  • Medical Physician Assistant
  • Seattle, WA
  • NPI 1386622546
  NPD
• Ralph T. Haller, M.D.

  • Orthopaedic Surgery Physician
  • Everett, WA
  • NPI 1164491429
  NPD
• Todd W. Havener, M.D.

  • Orthopaedic Hand Surgery Physician
  • Everett, WA
  • NPI 1659340289
  NPD
• Alexander Christopher Higgins, DO

  • Orthopaedic Surgery Physician
  • Everett, WA
  • NPI 1538665443
  NPD
• Bill K Huang, M.D.

  • Orthopaedic Surgery Physician
  • Everett, WA
  • NPI 1356361588
  NPD
• Tony H. Huynh, MD

  • Retina Specialist (Ophthalmology) Physician
  • Mountlake Terrace, WA
  • NPI 1669590782
  NPD
• David Alan Johnson, MD

  • Diagnostic Radiology Physician
  • Vancouver, WA
  • NPI 1770901696
  NPD

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

{
    "created_epoch": "1323043200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1622160000000",
    "number": "1841568946",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1750 112TH AVE NE STE D050",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980043779",
            "telephone_number": "206-215-3850",
            "fax_number": "206-215-3870"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1750 112TH AVE NE STE D050",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "98004",
            "telephone_number": "206-215-3850",
            "fax_number": "206-215-3870"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3105 Old Fairhaven Pkwy Ste 103",
            "address_purpose": "LOCATION",
            "city": "Bellingham",
            "state": "WA",
            "postal_code": "982258212",
            "country_code": "US",
            "telephone_number": "206-215-3850",
            "fax_number": "206-215-3870",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "215 E George Hopper Rd",
            "address_purpose": "LOCATION",
            "city": "Burlington",
            "state": "WA",
            "postal_code": "982333105",
            "country_code": "US",
            "telephone_number": "206-215-3850",
            "fax_number": "206-215-3870",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2205 W Dolarway Rd Ste 2",
            "address_purpose": "LOCATION",
            "city": "Ellensburg",
            "state": "WA",
            "postal_code": "989268241",
            "country_code": "US",
            "telephone_number": "206-215-3850",
            "fax_number": "206-215-3870",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1229 Madison St Ste 680",
            "address_purpose": "LOCATION",
            "city": "Seattle",
            "state": "WA",
            "postal_code": "981043541",
            "country_code": "US",
            "telephone_number": "206-215-3850",
            "fax_number": "206-215-3870",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1229 Madison St Ste 620",
            "address_purpose": "LOCATION",
            "city": "Seattle",
            "state": "WA",
            "postal_code": "981043304",
            "country_code": "US",
            "telephone_number": "206-215-3850",
            "fax_number": "206-215-3870",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6100 219th St SW Ste 280",
            "address_purpose": "LOCATION",
            "city": "Mountlake Terrace",
            "state": "WA",
            "postal_code": "980432222",
            "country_code": "US",
            "telephone_number": "206-215-3850",
            "fax_number": "206-215-3870",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "321 Ramsay Way Ste 107",
            "address_purpose": "LOCATION",
            "city": "Kent",
            "state": "WA",
            "postal_code": "980324544",
            "country_code": "US",
            "telephone_number": "206-215-3850",
            "fax_number": "206-215-3870",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "109 NE Birch St",
            "address_purpose": "LOCATION",
            "city": "Coupeville",
            "state": "WA",
            "postal_code": "982393133",
            "country_code": "US",
            "telephone_number": "206-215-3850",
            "fax_number": "206-215-3870",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PROLIANCE SURGEONS, INC., P.S.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-05",
        "last_updated": "2021-05-28",
        "certification_date": "2021-05-28",
        "status": "A",
        "authorized_official_last_name": "KLEISLE",
        "authorized_official_first_name": "LAURA",
        "authorized_official_title_or_position": "CHIEF RISK OFFICER",
        "authorized_official_telephone_number": "206-838-2590",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "WA",
            "license": "601484763",
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "WA",
            "license": "601484763",
            "primary": true
        },
        {
            "code": "207WX0107X",
            "taxonomy_group": "",
            "desc": "Ophthalmology, Retina Specialist",
            "state": "WA",
            "license": "601484763",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2016220",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LABOR & INDUSTRIES",
            "identifier": "288391",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Proliance Retina",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Proliance Surgeons, Inc., P.S. (Proliance Surgeons Bellevue Ear Nose and Throat and Sound Hearing)
• Proliance Surgeons, Inc., P.S. (Proliance Eastside Surgical Specialists)
• Proliance Surgeons, Inc., P.S. (The Retina Surgery Center)
• Proliance Surgeons, Inc., P.S. (Proliance Eastside Surgical Specialists)
• Proliance Surgeons, Inc., P.S. (Proliance Sports Therapy and Rehabilitation of Bellevue)
• Alexandra Prosser
• William Joseph Prothero, O.D.
• Tianna Prowell
• Valeriia Prudnikova
• Morgan Prutsman

• Ophthalmology Physician in Bellevue, WA
• Providers in Bellevue, WA by specialty
• Ophthalmology Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2021; 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.