Active NPI
Franciscan Medical Group
- Surgery Physician
- Tacoma, WA
National Provider Identifier
1912176108
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- Legal business name
- FRANCISCAN MEDICAL GROUP
- Practice address
- 1708 Yakima Ave
Suite 110
Tacoma, WA 98405-5307 - Phone
- (253) 383-5331
- Fax
- (253) 383-2596
- NPI assigned
- Feb 21, 2008
- Organization subpart
- Yes
- Parent organization
- FRANCISCAN MEDICAL GROUP
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Cliff Robertson, MD
- Title
- Chief Medical Officer
- Phone
- (253) 779-6101
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | Primary |
Addresses
Primary practice location
1708 Yakima Ave
Suite 110
Tacoma, WA 98405-5307
Mailing address
1708 S. Yamima Ave.
Suite 110
Tacoma, WA 98405-4252
Phone (253) 383-5331
Other names 1
- FMG-Northwest Surgical Associates
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031111000789 | WA | Part B Supplier - Clinic/Group Practice | 0547173866 |
Receives reassigned benefits from 1,720 practitioners This NPI is an additional NPI on the enrollment |
National Provider Directory
National Provider Directory- Part of
- Enumclaw Medical Center
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1203552000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1225756800000",
"number": "1912176108",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1708 S. YAMIMA AVE.",
"address_2": "SUITE 110",
"city": "TACOMA",
"state": "WA",
"postal_code": "984054252",
"telephone_number": "253-383-5331",
"fax_number": "253-383-2596"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1708 YAKIMA AVE",
"address_2": "SUITE 110",
"city": "TACOMA",
"state": "WA",
"postal_code": "984055307",
"telephone_number": "253-383-5331",
"fax_number": "253-383-2596"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "FRANCISCAN MEDICAL GROUP",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "FRANCISCAN MEDICAL GROUP",
"enumeration_date": "2008-02-21",
"last_updated": "2008-11-04",
"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_name_prefix": "Dr.",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Surgery",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "FMG-Northwest Surgical Associates",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Tacoma, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2008; 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.