NPIMap

Organization Active NPI

Western Washington Medical Group, Inc PS

Doing business as Western Wa Medical Group Dept of Endocrinology

  • Endocrinology, Diabetes & Metabolism Physician
  • Mukilteo, WA
National Provider Identifier
1902024300
Registry record updated Aug 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X
License
601474013 Issued in WA
Legal business name
WESTERN WASHINGTON MEDICAL GROUP, INC PS
Doing business as
Western Wa Medical Group Dept of Endocrinology
Practice address
8423 Mukilteo Speedway Ste 102
Mukilteo, WA 98275-3237
Phone
(425) 412-4311
Fax
(425) 374-8896
NPI assigned
Apr 23, 2007
Last updated
Aug 4, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
WESTERN WASHINGTON MEDICAL GROUPAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 4, 2023

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

Authorized official

Name
Amelia Edens
Title
Director of Patient Financial SVCS
Phone
(425) 740-4142

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Endocrinology, Diabetes & Metabolism Physician 207RE0101X 601474013 WA Primary

Addresses

Primary practice location

8423 Mukilteo Speedway Ste 102
Mukilteo, WA 98275-3237

Mailing address

1728 W Marine View Dr Ste 110
Everett, WA 98201-2094
Phone (425) 412-4311

Other identifiers 3

IdentifierTypeStateIssuer
0101673OtherWALABOR & INDUSTRY
7106347MedicaidWA
DA4340OtherWARAILROAD MEDICARE

Other names 1

  • Western Wa Medical Group Dept of Endocrinology Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031107000469 WA Part B Supplier - Clinic/Group Practice 7517870314 Receives reassigned benefits from 130 practitioners
32 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Everett, WA; Lynnwood, WA; Marysville, WA; Monroe, WA; Oak Harbor, WA; Snohomish, WA; Anacortes, WA; Arlington, WA…

Other NPIs on the same Medicare enrollment 32

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

View all 32

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
50D2229957Western Washington Medical Group8423 Mukilteo Speedway Ste 102, Mukilteo, WA 98275Certificate of waiverApr 4, 2028

National Provider Directory

National Provider Directory
Tax ID family
Western Wa Med Group21 organizations share this tax ID, including this one
Part of
Western Wa Med Group

Other organizations with this tax ID 20

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

View all 20

Locations

1330 Rockefeller Ave
Ste 330
Everett, WA 98201
Phone (425) 252-8375

1728 W Marine View Dr
Ste 106
Everett, WA 98201

Practitioners & affiliated clinicians

Practitioners 5

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": "1177286400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1691107200000",
    "number": "1902024300",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1728 W MARINE VIEW DR STE 110",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982012094",
            "telephone_number": "425-412-4311",
            "fax_number": "425-374-8896"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8423 MUKILTEO SPEEDWAY STE 102",
            "city": "MUKILTEO",
            "state": "WA",
            "postal_code": "982753237",
            "telephone_number": "425-412-4311",
            "fax_number": "425-374-8896"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WESTERN WASHINGTON MEDICAL GROUP, INC PS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WESTERN WASHINGTON MEDICAL GROUP",
        "enumeration_date": "2007-04-23",
        "last_updated": "2023-08-04",
        "certification_date": "2023-08-04",
        "status": "A",
        "authorized_official_last_name": "EDENS",
        "authorized_official_first_name": "AMELIA",
        "authorized_official_title_or_position": "DIRECTOR OF PATIENT FINANCIAL SVCS",
        "authorized_official_telephone_number": "425-740-4142"
    },
    "taxonomies": [
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "WA",
            "license": "601474013",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LABOR & INDUSTRY",
            "identifier": "0101673",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7106347",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DA4340",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Western Wa Medical Group Dept of Endocrinology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mukilteo, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2023; 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.