NPIMap

Organization Active NPI

Pain Care Physicians PLLC

  • Interventional Pain Medicine Physician
  • Bellevue, WA
National Provider Identifier
1871373894
Registry record updated Jul 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X
Legal business name
PAIN CARE PHYSICIANS PLLC
Practice address
1260 116TH Ave NE Ste 130
Bellevue, WA 98004-3800
Phone
(206) 538-6300
Fax
(206) 538-6301
NPI assigned
Oct 5, 2023
Last updated
Jul 21, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2025

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

Authorized official

Name
Kevin Brian Moon
Title
Director of Revenue and Finance
Phone
(206) 538-6300

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine Physician 208VP0000X NU
Interventional Pain Medicine Physician 208VP0014X NU Primary

Addresses

Primary practice location

1260 116TH Ave NE Ste 130
Bellevue, WA 98004-3800

Mailing address

801 SW 16TH St Ste 121
Renton, WA 98057-2628
Phone (206) 538-6300

Other identifiers 1

IdentifierTypeStateIssuer
1144779232OtherBILLING NPI

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20161107001926 WA Part B Supplier - Clinic/Group Practice 9537448931 Receives reassigned benefits from 18 practitioners
7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Everett, WA; Bellevue, WA; Tacoma, WA; Spokane Valley, WA; Olympia, WA; Renton, WA

Other NPIs on the same Medicare enrollment 6

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
50D2297037Pain Care Physicians PLLC1260 116TH Ave NE Ste 130, Bellevue, WA 98004Certificate of waiverApr 4, 2028

National Provider Directory

National Provider Directory
Tax ID family
Pain Care Physicians PLLC6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Locations

1260 116th Ave NE
Ste 130
Bellevue, WA 98004

155 Lilly Rd NE
Ste B
Olympia, WA 98506

Practitioners & affiliated clinicians

Practitioners 9

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": "1696464000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1753056000000",
    "number": "1871373894",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 SW 16TH ST STE 121",
            "city": "RENTON",
            "state": "WA",
            "postal_code": "980572628",
            "telephone_number": "206-538-6300",
            "fax_number": "206-538-6301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1260 116TH AVE NE STE 130",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980043800",
            "telephone_number": "206-538-6300",
            "fax_number": "206-538-6301"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAIN CARE PHYSICIANS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-10-05",
        "last_updated": "2025-07-21",
        "certification_date": "2025-07-21",
        "status": "A",
        "authorized_official_last_name": "MOON",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "BRIAN",
        "authorized_official_title_or_position": "DIRECTOR OF REVENUE AND FINANCE",
        "authorized_official_telephone_number": "206-538-6300"
    },
    "taxonomies": [
        {
            "code": "208VP0000X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Pain Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BILLING NPI",
            "identifier": "1144779232",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.