Franciscan Medical Group

Primary specialty

Otolaryngology PhysicianTaxonomy code 207Y00000X

License

MD00029182 Issued in WA

Legal business name

FRANCISCAN MEDICAL GROUP

Practice address

4700 Point Fosdick Dr NW
Ste 320
Gig Harbor, WA 98335-1706

Phone

(253) 627-6731

Fax

(253) 627-1064

NPI assigned

May 15, 2007

Organization subpart

Yes

Parent organization

FRANCISCAN MEDICAL GROUPAs reported in NPPES

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

Authorized official

Name

Cliff Robertson, MD

Title

Chief Medical Officer

Phone

(253) 779-6101

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Franciscan Ear, Nose & Throat Associates (Federal Way) Doing business as

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

Part of

Enumclaw Medical Center

Locations

Practitioners 4

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

• Rachelle Vicencio, MD

  • Pediatrics Physician
  • Tacoma, WA
  • NPI 1629260534
  NPD
• Chelsea Lundstrom Crosby, PA-C

  • Physician Assistant
  • Burien, WA
  • NPI 1861715310
  NPD (past)
• Stephanie K Fraser, PA-C

  • Medical Physician Assistant
  • Tacoma, WA
  • NPI 1598090656
  NPD (past)
• Jeffrey Dana Wiedemann, PHARMD

  • Pharmacist
  • Hillsboro, OR
  • NPI 1578873022
  NPD (past)

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

{
    "created_epoch": "1179187200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1312156800000",
    "number": "1891901286",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4700 POINT FOSDICK DR NW",
            "address_2": "STE 320",
            "city": "GIG HARBOR",
            "state": "WA",
            "postal_code": "983351706",
            "telephone_number": "253-627-6731",
            "fax_number": "253-627-1064"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4700 POINT FOSDICK DR NW",
            "address_2": "STE 320",
            "city": "GIG HARBOR",
            "state": "WA",
            "postal_code": "983351706",
            "telephone_number": "253-627-6731",
            "fax_number": "253-627-1064"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FRANCISCAN MEDICAL GROUP",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FRANCISCAN MEDICAL GROUP",
        "enumeration_date": "2007-05-15",
        "last_updated": "2011-08-01",
        "status": "A",
        "authorized_official_last_name": "ROBERTSON",
        "authorized_official_first_name": "CLIFF",
        "authorized_official_title_or_position": "CHIEF MEDICAL OFFICER",
        "authorized_official_telephone_number": "253-779-6101",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Otolaryngology",
            "state": "WA",
            "license": "MD00029182",
            "primary": true
        },
        {
            "code": "231H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Audiologist",
            "state": "WA",
            "license": "LD00001211",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7137920",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE L&I",
            "identifier": "0223168",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Franciscan Ear, Nose & Throat Associates (Federal Way)",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Franciscan Medical Group
• Franciscan Medical Group
• Franciscan Medical Group
• Franciscan Medical Group
• Franciscan Medical Group
• Franciscan Medical Group
• Franciscan Medical Group
• Franciscan Medical Group
• Franciscan Medical Group
• Franciscan Medical Group

• Otolaryngology Physician in Gig Harbor, WA
• Providers in Gig Harbor, WA by specialty
• Otolaryngology Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2011; 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.