NPIMap

Organization Active NPI

Professional Recreation Organization, Inc.

Doing business as PRO Sports Club

  • Family Medicine Physician
  • Bellevue, WA
National Provider Identifier
1861918518
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
600541508 Issued in WA
Legal business name
PROFESSIONAL RECREATION ORGANIZATION, INC.
Doing business as
PRO Sports Club
Practice address
4455 148TH Ave NE
Bellevue, WA 98007-3120
Phone
(425) 895-6575
NPI assigned
Aug 15, 2017
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Debbie Becker
Title
Sr Director of Accounting
Phone
(425) 869-4746

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 600541508 WA Primary
General Practice Physician 208D00000X 600541508 WA

Addresses

Primary practice location

4455 148TH Ave NE
Bellevue, WA 98007-3120

Mailing address

4455 148TH Ave NE
Bellevue, WA 98007-3120
Phone (425) 895-6575

Other names 1

  • PRO Sports Club Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Pro Sports Club14 organizations share this tax ID, including this one

Other organizations with this tax ID 13

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

View all 13

Practitioners & affiliated clinicians

Practitioners 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1502755200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1861918518",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4455 148TH AVE NE",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980073120",
            "telephone_number": "425-895-6575"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4455 148TH AVE NE",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980073120",
            "telephone_number": "425-895-6575"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL RECREATION ORGANIZATION, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-15",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "BECKER",
        "authorized_official_first_name": "DEBBIE",
        "authorized_official_title_or_position": "SR DIRECTOR OF ACCOUNTING",
        "authorized_official_telephone_number": "425-869-4746"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "600541508",
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "WA",
            "license": "600541508",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PRO Sports Club",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bellevue, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.