South Sound Radiologists Inc P S
Organization Active NPI Diagnostic Radiology Physician · Olympia, WA
NPI 1902990500 · NPPES record last updated Jan 17, 2022
Key facts
- NPI
- 1902990500
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Diagnostic Radiology Physician 2085R0202X
- Legal business name
- SOUTH SOUND RADIOLOGISTS INC P S
- Practice address
- 3417 Ensign Rd NE
Olympia, WA 98506-5064 - Phone
- (360) 493-4600
- Fax
- (360) 493-4603
- NPI assigned
- Oct 3, 2006
- Organization subpart
- No
Authorized official
- Name
- Dr. Charles Hao Shen, MD
- Title
- Authorized Official
- Phone
- (425) 563-1500
Member organizations 1
Practitioners 261
-
Dae Hee Bang, M.D.
-
Robert D Bloch, MD
-
Herbert W. Chen, M.D.
-
Jonathan Merlin Davison, M.D.
-
Patrick Thomas Flanagan, M.D.
-
Arman Forouzannia, M.D.
-
Kavita Gulati, MD
-
Ben Hugh Harmon, MD
-
Dawn Marie Hastreiter, MD, PHD
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 50D1071153 | South Sound Radiology | Certificate of waiver | Apr 4, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (33 enrollments) in WA, GA, CA, OR, VA, UT, AZ, FL, MA, TX, MI, NE, AL, IN, NV, NC, DC, ID, IA, PA, SC, CO, MO, MT, CT, OH, HI, OK, ME, LA, TN, IL, SD
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040309001119 | WA | Part B Supplier - Clinic/Group Practice | 1254229305 | Receives reassigned benefits from 201 practitioners |
| O20201116000402 | GA | Part B Supplier - Clinic/Group Practice | 1254229305 |
Receives reassigned benefits from 1 practitioner Practice locations: Suwanee, GA |
| O20220716000327 | CA | Part B Supplier - Clinic/Group Practice | 1254229305 |
Receives reassigned benefits from 12 practitioners Practice locations: Novato, CA; Torrance, CA; Temple City, CA; Santa Barbara, CA; Redding, CA; Pasadena, CA; Palm Desert, CA; Newport Beach, CA… |
| O20220716000347 | OR | Part B Supplier - Clinic/Group Practice | 1254229305 |
Receives reassigned benefits from 6 practitioners Practice locations: Bend, OR; Portland, OR; Medford, OR; Eagle Point, OR; Ashland, OR |
| O20220720002656 | VA | Part B Supplier - Clinic/Group Practice | 1254229305 |
Receives reassigned benefits from 2 practitioners Practice locations: Reston, VA; Virginia Beach, VA |
| O20220801002920 | UT | Part B Supplier - Clinic/Group Practice | 1254229305 |
Receives reassigned benefits from 4 practitioners Practice locations: Ivins, UT; Park City, UT; Salt Lake City, UT; Washington, UT |
| O20220808002471 | AZ | Part B Supplier - Clinic/Group Practice | 1254229305 |
Receives reassigned benefits from 4 practitioners Practice locations: Cave Creek, AZ; Phoenix, AZ; Scottsdale, AZ |
| O20220901000758 | FL | Part B Supplier - Clinic/Group Practice | 1254229305 |
Receives reassigned benefits from 2 practitioners Practice locations: Coral Gables, FL; Ponte Vedra, FL; Jacksonville, FL |
| O20221108002061 | MA | Part B Supplier - Clinic/Group Practice | 1254229305 |
Receives reassigned benefits from 1 practitioner Practice locations: Milton, MA |
| O20221203000061 | TX | Part B Supplier - Clinic/Group Practice | 1254229305 |
Receives reassigned benefits from 11 practitioners Practice locations: Austin, TX; San Antonio, TX; Houston, TX; Grapevine, TX; Georgetown, TX; Flower Mound, TX; Boerne, TX; Belton, TX |
| O20240110003034 | MI | Part B Supplier - Clinic/Group Practice | 1254229305 |
Receives reassigned benefits from 2 practitioners Practice locations: Ann Arbor, MI; Grand Rapids, MI |
| O20240216001001 | NE | Part B Supplier - Clinic/Group Practice | 1254229305 |
Receives reassigned benefits from 1 practitioner Practice locations: Hastings, NE |
| O20240228002664 | AL | Part B Supplier - Clinic/Group Practice | 1254229305 |
Receives reassigned benefits from 1 practitioner Practice locations: Birmingham, AL |
| O20240510001680 | IN | Part B Supplier - Clinic/Group Practice | 1254229305 |
Receives reassigned benefits from 1 practitioner Practice locations: Greentown, IN |
| O20240620002540 | NV | Part B Supplier - Clinic/Group Practice | 1254229305 |
Receives reassigned benefits from 1 practitioner Practice locations: Las Vegas, NV |
| O20240708001716 | NC | Part B Supplier - Clinic/Group Practice | 1254229305 |
Receives reassigned benefits from 2 practitioners Practice locations: Cary, NC; Charlotte, NC; Hickory, NC |
| O20240718004865 | DC | Part B Supplier - Clinic/Group Practice | 1254229305 |
Receives reassigned benefits from 3 practitioners Practice locations: Clarksburg, MD; Reston, VA; Washington, DC; Alexandira, VA |
| O20240805003042 | ID | Part B Supplier - Clinic/Group Practice | 1254229305 |
Receives reassigned benefits from 1 practitioner Practice locations: Hayden, ID |
| O20240827001033 | IA | Part B Supplier - Clinic/Group Practice | 1254229305 |
Receives reassigned benefits from 1 practitioner Practice locations: Bettendorf, IA |
| O20240902000420 | PA | Part B Supplier - Clinic/Group Practice | 1254229305 |
Receives reassigned benefits from 1 practitioner Practice locations: Export, PA |
| O20240923004061 | SC | Part B Supplier - Clinic/Group Practice | 1254229305 |
Receives reassigned benefits from 2 practitioners Practice locations: Daniel Island, SC; Sullivans Island, SC |
| O20241014003781 | CO | Part B Supplier - Clinic/Group Practice | 1254229305 |
Receives reassigned benefits from 2 practitioners Practice locations: Broomfield, CO; Littleton, CO |
| O20241016000891 | MO | Part B Supplier - Clinic/Group Practice | 1254229305 |
Receives reassigned benefits from 3 practitioners Practice locations: Jackson, MO; Kansas City, MO; Kirkwood, MO; Saint Louis, MO |
| O20250428001890 | MT | Part B Supplier - Clinic/Group Practice | 1254229305 |
Receives reassigned benefits from 1 practitioner Practice locations: Kalispell, MT |
| O20250605000346 | CT | Part B Supplier - Clinic/Group Practice | 1254229305 |
Receives reassigned benefits from 1 practitioner Practice locations: Easton, CT; Fairfield, CT |
| O20250610002798 | OH | Part B Supplier - Clinic/Group Practice | 1254229305 |
Receives reassigned benefits from 2 practitioners Practice locations: Cleveland, OH; Marietta, OH |
| O20250815000450 | HI | Part B Supplier - Clinic/Group Practice | 1254229305 |
Receives reassigned benefits from 1 practitioner Practice locations: Honolulu, HI |
| O20250904004416 | OK | Part B Supplier - Clinic/Group Practice | 1254229305 |
Receives reassigned benefits from 1 practitioner Practice locations: Oklahoma City, OK |
| O20250910000596 | ME | Part B Supplier - Clinic/Group Practice | 1254229305 |
Receives reassigned benefits from 1 practitioner Practice locations: Carrabassett Valley, ME; Cushing, ME |
| O20250916001916 | LA | Part B Supplier - Clinic/Group Practice | 1254229305 |
Receives reassigned benefits from 1 practitioner Practice locations: Baton Rouge, LA |
| O20251008003314 | TN | Part B Supplier - Clinic/Group Practice | 1254229305 |
Receives reassigned benefits from 2 practitioners Practice locations: Knoxville, TN; Memphis, TN |
| O20251015000651 | IL | Part B Supplier - Clinic/Group Practice | 1254229305 |
Receives reassigned benefits from 1 practitioner Practice locations: Barrington, IL |
| O20251022002777 | SD | Part B Supplier - Clinic/Group Practice | 1254229305 |
Receives reassigned benefits from 1 practitioner Practice locations: Rapid City, SD |
National Provider Directory
Locations
383 Kalaimoku St
Ste D2708
Honolulu, HI 96815
908 S Scheuber Rd
Centralia, WA 98531
Phone (360) 330-8507
4800 College St SE
Olympia, WA 98503
Phone (360) 456-7575
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diagnostic Radiology Physician |
2085R0202X | Yes |
Addresses
Primary practice location
3417 Ensign Rd NE
Olympia, WA 98506-5064
Mailing address
19020 33Rd Ave W Ste 210
Lynnwood, WA 98036-4748
Phone (425) 563-1500
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 034600 | Other | WA | L & I |
| 7871908 | Medicaid | WA | |
| 1046150 | Medicaid | WA |
Other names
- South Sound Radiology
Other providers in Olympia, WA
- South Sound Oral Surgery PLLC
- South Sound Pediatrics PLLC
- South Sound Pediatrics PLLC
- South Sound Physical & Hand Therapy PLLC
- South Sound Pulmonary Associates
- South Sound Surgical Associates
- South Sound Vasectomy and Men'S Health
- South Sound Women'S Center LLP
- Jakob Larz South
- Craig Longridge Southwell
All providers in Olympia, WA · Diagnostic Radiology Physician in Washington
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 17, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.