Active NPI
Franciscan Medical Group
Doing business as Lakes Family Medicine-Puyallup
- Family Medicine Physician
- Puyallup, WA
National Provider Identifier
1871786483
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- Legal business name
- FRANCISCAN MEDICAL GROUP
- Doing business as
- Lakes Family Medicine-Puyallup
- Practice address
- 10116 116TH St E
Ste 101
Puyallup, WA 98373-3543 - Phone
- (253) 864-0224
- Fax
- (253) 864-0634
- NPI assigned
- Aug 27, 2007
- Last updated
- Feb 20, 2008
- Organization subpart
- Yes
- Parent organization
- FRANCISCAN MEDICAL GROUP
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Cliff A. Robertson, MD
- Title
- President/ Chief Medical Officer
- Phone
- (253) 779-6101
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | WA | Primary |
Addresses
Primary practice location
10116 116TH St E
Ste 101
Puyallup, WA 98373-3543
Mailing address
10116 116TH St E
Ste 101
Puyallup, WA 98373-3543
Phone (253) 864-0224
Other names 1
- Lakes Family Medicine-Puyallup
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031111000789 | WA | Part B Supplier - Clinic/Group Practice | 0547173866 |
Receives reassigned benefits from 1,720 practitioners This NPI is an additional NPI on the enrollment |
National Provider Directory
National Provider Directory- Part of
- CHI Franciscan Health
Locations
112 43rd Ave SW
Ste 101
Puyallup, WA 98373
Phone (253) 864-0224
Practitioners & affiliated clinicians
Practitioners 2
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.
-
- Family Medicine Physician
- Puyallup, WA
- NPI 1508881228
-
- Family Medicine Physician
- Spanaway, WA
- NPI 1417976440
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1188172800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1203465600000",
"number": "1871786483",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10116 116TH ST E",
"address_2": "STE 101",
"city": "PUYALLUP",
"state": "WA",
"postal_code": "983733543",
"telephone_number": "253-864-0224",
"fax_number": "253-864-0634"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10116 116TH ST E",
"address_2": "STE 101",
"city": "PUYALLUP",
"state": "WA",
"postal_code": "983733543",
"telephone_number": "253-864-0224",
"fax_number": "253-864-0634"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "FRANCISCAN MEDICAL GROUP",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "FRANCISCAN MEDICAL GROUP",
"enumeration_date": "2007-08-27",
"last_updated": "2008-02-20",
"status": "A",
"authorized_official_last_name": "ROBERTSON",
"authorized_official_first_name": "CLIFF",
"authorized_official_middle_name": "A.",
"authorized_official_title_or_position": "PRESIDENT/ CHIEF MEDICAL OFFICER",
"authorized_official_telephone_number": "253-779-6101",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Family Medicine",
"state": "WA",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Lakes Family Medicine-Puyallup",
"code": "3",
"type": "Doing Business As"
}
]
}
Other providers in Puyallup, WA
- Franciscan Medical Group
- Franciscan Medical Group (FMG-Neurosurgery NW - Puyallup)
- Franciscan Medical Group (Franciscan Digestive Care Associates-Puyallup)
- Franciscan Medical Group (Franciscan Medical Clinic-Canyon Road)
- Franciscan Medical Group (Franciscan Prompt Care)
- Franciscan Medical Group (All Family Medicine)
- Rachelle Francois Tate
- Robert Jay Frank, MD
- Jordan Fraser
- Joye Lynn Fratoni, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2008; 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.