NPIMap

Organization Active NPI

Proliance Surgeons, Inc., P.S.

  • Plastic Surgery Physician
  • Renton, WA
National Provider Identifier
1841610169
Registry record updated Jul 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic Surgery PhysicianTaxonomy code 208200000X
Legal business name
PROLIANCE SURGEONS, INC., P.S.
Practice address
17930 Talbot Rd S
Renton, WA 98055-6230
Phone
(425) 228-3187
Fax
(425) 228-7972
NPI assigned
Apr 25, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 28, 2022

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Plastic Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208200000X 601484763 WA
Plastic Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208200000X Primary

Addresses

Primary practice location

17930 Talbot Rd S
Renton, WA 98055-6230

Mailing address

17930 Talbot Rd S
Renton, WA 98055-6230
Phone (425) 228-3187

Other practice location 1

23925 225th Way SE Ste B
Maple Valley, WA 98038-5291
Phone (425) 228-3187

Other identifiers 2

IdentifierTypeStateIssuer
2036917MedicaidWA
326119OtherWAWA L&I

Other names 1

  • PLASTIC & RECONSTRUCTIVE SURGEONS Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031119000128 WA Part B Supplier - Clinic/Group Practice 8527972900 Receives reassigned benefits from 781 practitioners
This NPI is an additional NPI on the enrollment

National Provider Directory

National Provider Directory

Locations

23925 225th Way SE
Ste B
Maple Valley, WA 98038
Phone (425) 228-3187

Practitioners & affiliated clinicians

Practitioners 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1398384000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658966400000",
    "number": "1841610169",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17930 TALBOT RD S",
            "city": "RENTON",
            "state": "WA",
            "postal_code": "980556230",
            "telephone_number": "425-228-3187",
            "fax_number": "204-228-7972"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17930 TALBOT RD S",
            "city": "RENTON",
            "state": "WA",
            "postal_code": "980556230",
            "telephone_number": "425-228-3187",
            "fax_number": "425-228-7972"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "23925 225th Way SE Ste B",
            "address_purpose": "LOCATION",
            "city": "Maple Valley",
            "state": "WA",
            "postal_code": "980385291",
            "country_code": "US",
            "telephone_number": "425-228-3187",
            "fax_number": "425-228-7972",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PROLIANCE SURGEONS, INC., P.S.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-25",
        "last_updated": "2022-07-28",
        "certification_date": "2022-07-28",
        "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": "208200000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Plastic Surgery",
            "state": "WA",
            "license": "601484763",
            "primary": false
        },
        {
            "code": "208200000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Plastic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2036917",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WA L&I",
            "identifier": "326119",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PLASTIC & RECONSTRUCTIVE SURGEONS",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "PLASTIC & RECONSTRUCTIVE SURGEONS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Renton, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2022; 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.