NPIMap

Organization Active NPI

N W Pediatric Center Inc P S

Doing business as Northwest Pediatric Center

  • Pediatrics Physician
  • Centralia, WA
National Provider Identifier
1912515917
Registry record updated Oct 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
N W PEDIATRIC CENTER INC P S
Doing business as
Northwest Pediatric Center
Practice address
1915 Cooks Hill Rd
Centralia, WA 98531-9073
Phone
(360) 736-6778
Fax
(360) 736-6552
NPI assigned
Jul 16, 2020
Last updated
Oct 9, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
N W PEDIATRIC CENTER, INC. P.S.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 9, 2025

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

Authorized official

Name
Lisa G McKay
Title
Practice Manager
Phone
(360) 736-6778

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X
Mental Health Counselor 101YM0800X
Pediatrics Physician 208000000X Primary
Child & Adolescent Psychiatry Physician 2084P0804X

Addresses

Primary practice location

1915 Cooks Hill Rd
Centralia, WA 98531-9073

Mailing address

1911 Cooks Hill Rd
Centralia, WA 98531-9073
Phone (360) 736-6778

Other names 1

  • Northwest Pediatric Center Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address awhaley@nwpc.opdirect.net

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200903001577 WA Part A Provider - Rural Health Clinic 8022929553 Practice locations: Centralia, WA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1912515917. Details of each certification follow.

Rural health clinic certification: CCN 503928

Legal name
N W PEDIATRIC CENTER INC PS
Doing business as
NORTHWEST PEDIATRIC CENTER
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Mar 30, 2021
Last certification
Mar 30, 2021
Ownership / control type
1B
Organization structure
CorporationProprietary
Incorporated
Oct 1, 1992 in WA
Enrollment address
1915 Cooks Hill Rd
Centralia, WA 98531-9073

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
50D2189442Northwest Pediatric Center1915 Cooks Hill Rd, Centralia, WA 98531Certificate of waiverApr 4, 2028

National Provider Directory

National Provider Directory
Part of
N W Pediatric Center Inc PS

Locations

1911 Cooks Hill Rd
Centralia, WA 98531
Phone (360) 736-6552

Interoperability endpoints

  • Direct secure messaging: awhaley@nwpc.opdirect.net

Ownership & related parties

All disclosed owners & managing parties 8

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Maria Rowena C Ramirez Individual 5% Or Greater Direct Ownership Interest Jul 1, 2015 15.15%
Corporate DirectorDirector Jul 1, 2015
Joesph W Wiley Individual Corporate DirectorSecretary May 1, 1995
Jemima Tso Individual 5% Or Greater Direct Ownership Interest Jul 1, 1997 15.15%
Corporate DirectorTreasurer Jul 1, 1997
Lily L Lo Individual 5% Or Greater Direct Ownership Interest Jun 1, 2000 15.15%
Corporate DirectorVice President Jun 1, 2000
Jennifer Polley Individual 5% Or Greater Direct Ownership Interest Oct 1, 1992
Lisa G McKay Individual W-2 Managing EmployeeAdministrator Jul 21, 2020
Aaron Dalan Individual 5% Or Greater Direct Ownership Interest Aug 1, 2008 15.15%
Corporate DirectorDirector Aug 1, 2008
Jennifer J Caserta Individual 5% Or Greater Direct Ownership Interest Aug 15, 2004 9.1%
Corporate DirectorDirector Aug 15, 2004

Practitioners & affiliated clinicians

Practitioners 13

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 13

NPI Registry JSON

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

{
    "created_epoch": "1594857600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1759968000000",
    "number": "1912515917",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1911 COOKS HILL RD",
            "city": "CENTRALIA",
            "state": "WA",
            "postal_code": "985319073",
            "telephone_number": "360-736-6778",
            "fax_number": "360-736-6552"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1915 COOKS HILL RD",
            "city": "CENTRALIA",
            "state": "WA",
            "postal_code": "985319073",
            "telephone_number": "360-736-6778",
            "fax_number": "360-736-6552"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "N W PEDIATRIC CENTER INC P S",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "N W PEDIATRIC CENTER, INC. P.S.",
        "enumeration_date": "2020-07-16",
        "last_updated": "2025-10-09",
        "certification_date": "2025-10-09",
        "status": "A",
        "authorized_official_last_name": "MCKAY",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "360-736-6778"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "awhaley@nwpc.opdirect.net",
            "affiliation": "N",
            "address_1": "1915 Cooks Hill Rd",
            "city": "Centralia",
            "state": "WA",
            "country_code": "US",
            "postal_code": "985319073",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Northwest Pediatric Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Centralia, WA

Sources for this page

Verify at the official NPI Registry.