NPIMap

Organization Active NPI

Peacehealth

Doing business as Peace Island Medical Center

  • Family Medicine Physician
  • Friday Harbor, WA
National Provider Identifier
1902232507
Registry record updated Mar 5, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
HAC.FS.60316803 Issued in WA
Legal business name
PEACEHEALTH
Doing business as
Peace Island Medical Center
Practice address
1117 Spring St
Friday Harbor, WA 98250-9782
Phone
(360) 378-2141
NPI assigned
Sep 16, 2013
Last updated
Mar 5, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 5, 2025

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

Authorized official

Name
Mr. Ronald Lynn Saxton
Title
Evp & General Counsel
Phone
(360) 729-1108

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X HAC.FS.60316803 WA Primary
Medical Oncology Physician 207RX0202X HAC.FS.60316803 WA

Addresses

Primary practice location

1117 Spring St
Friday Harbor, WA 98250-9782

Mailing address

1115 SE 164TH Ave Dept 358
Vancouver, WA 98683-8004
Phone (360) 729-2161

Other names 1

  • Peace Island Medical Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130122000273 WA Part B Supplier - Clinic/Group Practice 9335391044 Receives reassigned benefits from 91 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Friday Harbor, WA; Redmond, WA; Seattle, WA

Other NPIs on the same Medicare enrollment 1

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

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
50D0684753Peace Island Medical Center Laboratory1117 Spring St, Friday Harbor, WA 98250ComplianceApr 4, 2028

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 47

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.

View all 47

NPI Registry JSON

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

{
    "created_epoch": "1379289600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1741132800000",
    "number": "1902232507",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1115 SE 164TH AVE DEPT 358",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986838004",
            "telephone_number": "360-729-2161",
            "fax_number": "541-431-8213"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1117 SPRING ST",
            "city": "FRIDAY HARBOR",
            "state": "WA",
            "postal_code": "982509782",
            "telephone_number": "360-378-2141"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEACEHEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-09-16",
        "last_updated": "2025-03-05",
        "certification_date": "2025-03-05",
        "status": "A",
        "authorized_official_last_name": "SAXTON",
        "authorized_official_first_name": "RONALD",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "EVP & GENERAL COUNSEL",
        "authorized_official_telephone_number": "360-729-1108",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "HAC.FS.60316803",
            "primary": true
        },
        {
            "code": "207RX0202X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Medical Oncology",
            "state": "WA",
            "license": "HAC.FS.60316803",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Peace Island Medical Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Peace Island Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Friday Harbor, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2025; 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.