NPIMap

Organization Active NPI

Puget Sound Kidney Centers

Doing business as Puget Sound Kidney Center-Poulsbo

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Poulsbo, WA
National Provider Identifier
1881358984
Registry record updated Oct 25, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
Legal business name
PUGET SOUND KIDNEY CENTERS
Doing business as
Puget Sound Kidney Center-Poulsbo
Practice address
19472 Powder Hill PL NE Ste 100
Poulsbo, WA 98370-7473
Phone
(360) 598-9712
Fax
(360) 930-0703
NPI assigned
Oct 25, 2021
Last updated
Oct 25, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 25, 2021

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

Authorized official

Name
Harold Kelly
Title
President & Ceo
Phone
(425) 259-5195

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X Primary

Addresses

Primary practice location

19472 Powder Hill PL NE Ste 100
Poulsbo, WA 98370-7473

Mailing address

1019 Pacific Ave
Everett, WA 98201-4148
Phone (425) 259-1884

Other names 1

  • Puget Sound Kidney Center-Poulsbo Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210716001116 WA Part A Provider - End-Stage Renal Disease Facility (ESRD) 3476501560 Practice locations: Poulsbo, WA

Other NPIs with the same Medicare PAC ID 11

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

Care Compare: Dialysis facility

Medicare Care Compare
Listed as
Puget Sound Kidney Center-PoulsboCCN 502549
Overall star rating
4.0 of 5
Ownership
Non-profit
Certified
Jun 19, 2006
Medicare certification status
ActiveFrom the Provider of Services file
Chain
Puget Sound Kidney Centers
Dialysis stations
11

Name & address match This facility record has no NPI; it was connected to this NPI by matching name and address.

National Provider Directory

National Provider Directory
Tax ID family
Puget Sound Kidney Centers11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

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

Practitioners & affiliated clinicians

Affiliated clinicians 4

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1635120000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1635120000000",
    "number": "1881358984",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1019 PACIFIC AVE",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982014148",
            "telephone_number": "425-259-1884"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19472 POWDER HILL PL NE STE 100",
            "city": "POULSBO",
            "state": "WA",
            "postal_code": "983707473",
            "telephone_number": "360-598-9712",
            "fax_number": "360-930-0703"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PUGET SOUND KIDNEY CENTERS",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-25",
        "last_updated": "2021-10-25",
        "certification_date": "2021-10-22",
        "status": "A",
        "authorized_official_last_name": "KELLY",
        "authorized_official_first_name": "HAROLD",
        "authorized_official_title_or_position": "PRESIDENT & CEO",
        "authorized_official_telephone_number": "425-259-5195"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Puget Sound Kidney Center-Poulsbo",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Poulsbo, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2021; 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.