NPIMap

Organization Active NPI

Pacific Vascular Incorporated

  • Physiological Laboratory
  • Sequim, WA
National Provider Identifier
1891017992
Registry record updated Dec 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physiological LaboratoryTaxonomy code 293D00000X
Legal business name
PACIFIC VASCULAR INCORPORATED
Practice address
536 N 5TH Ave
Suite B
Sequim, WA 98382-3079
Phone
(360) 582-0000
Fax
(425) 486-8976
NPI assigned
Feb 17, 2010
Organization subpart
Yes
Parent organization
PACIFIC VASCULAR INCORPORATEDAs reported in NPPES

Authorized official

NPPES NPI Registry
Name
Bonnie M Brown, RVT
Title
Ceo
Phone
(425) 398-7781

Other NPIs with the same Medicare PAC ID 13

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

View all 13

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 15

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100414000823 WA Part B Supplier - Independent Diagnostic Testing Facility (Idtf) 9739073388 Practice locations: Sequim, WA

National Provider Directory

National Provider Directory
Tax ID family
Pacific Vascular Incor15 organizations share this tax ID, including this one
Part of
Pacific Vascular Incor

Other organizations with this tax ID 14

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

View all 14

Locations

568 N 5th Ave
Unit 4
Sequim, WA 98382

536 N 5th Ave
#B
Sequim, WA 98382
Phone (360) 582-0000

568 N 5th Ave
Ste 4
Sequim, WA 98382
Phone (360) 582-0000

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Physiological Laboratory 293D00000X Primary

Addresses

NPPES NPI Registry

Primary practice location

536 N 5TH Ave
Suite B
Sequim, WA 98382-3079

Mailing address

11714 N Creek Pkwy N Ste 100
Bothell, WA 98011-8250
Phone (425) 486-8868

Other identifiers 1

NPPES NPI Registry
IdentifierTypeStateIssuer
7015852MedicaidWA

Other names 1

NPPES NPI Registry
  • Pacific Vascular-Sequim Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Dec 2, 2025.

{
    "created_epoch": "1266364800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1764633600000",
    "number": "1891017992",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11714 N CREEK PKWY N STE 100",
            "city": "BOTHELL",
            "state": "WA",
            "postal_code": "980118250",
            "telephone_number": "425-486-8868",
            "fax_number": "425-486-8976"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "536 N 5TH AVE",
            "address_2": "SUITE B",
            "city": "SEQUIM",
            "state": "WA",
            "postal_code": "983823079",
            "telephone_number": "360-582-0000",
            "fax_number": "425-486-8976"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFIC VASCULAR INCORPORATED",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PACIFIC VASCULAR INCORPORATED",
        "enumeration_date": "2010-02-17",
        "last_updated": "2025-12-02",
        "certification_date": "2025-12-02",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "BONNIE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "425-398-7781",
        "authorized_official_credential": "RVT"
    },
    "taxonomies": [
        {
            "code": "293D00000X",
            "taxonomy_group": "",
            "desc": "Physiological Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7015852",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pacific Vascular-Sequim",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Pacific Vascular-Sequim",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sequim, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 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.