NPIMap

Organization Active NPI

Fasa Family Wellness, PLLC

  • Foot & Ankle Surgery Podiatrist
  • Longview, WA
National Provider Identifier
1861495640
Registry record updated May 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
License
PO00000488 Issued in WA
Legal business name
FASA FAMILY WELLNESS, PLLC
Practice address
1114 Broadway St
Longview, WA 98632-3842
Phone
(360) 577-3682
Fax
(360) 577-1871
NPI assigned
May 24, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 29, 2025

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

Authorized official

Name
Terrence Eugene Hess
Title
Owner
Phone
(360) 754-3338

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Foot & Ankle Surgery PodiatristGroup: 193400000X SINGLE SPECIALTY GROUP 213ES0103X PO00000488 WA Primary
Durable Medical Equipment & Medical Supplies 332B00000X

Addresses

Primary practice location

1114 Broadway St
Longview, WA 98632-3842

Mailing address

PO Box 825159
Philadelphia, PA 19182-5159
Phone (360) 577-3682

Other names 1

  • Ankle & Foot Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240221002599 WA DME Supplier - Physician - Podiatry 7618290297 Practice locations: Longview, WA

Other NPIs with the same Medicare PAC ID 8

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

National Provider Directory

National Provider Directory
Tax ID family
Fasa Family Wellness PLLC12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

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

Locations

1114 Broadway St
Longview, WA 98632
Phone (360) 577-3682

NPI Registry JSON

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

{
    "created_epoch": "1116892800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1748476800000",
    "number": "1861495640",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 825159",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191825159",
            "telephone_number": "360-577-3682",
            "fax_number": "360-577-1871"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1114 BROADWAY ST",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "986323842",
            "telephone_number": "360-577-3682",
            "fax_number": "360-577-1871"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FASA FAMILY WELLNESS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-05-24",
        "last_updated": "2025-05-29",
        "certification_date": "2025-05-29",
        "status": "A",
        "authorized_official_last_name": "HESS",
        "authorized_official_first_name": "TERRENCE",
        "authorized_official_middle_name": "EUGENE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "360-754-3338"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "WA",
            "license": "PO00000488",
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ankle & Foot Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Longview, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 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.