NPIMap

Organization Active NPI

Priyan Perera MD PLLC

  • Internal Medicine Physician
  • Tacoma, WA
National Provider Identifier
1912563982
Registry record updated Jul 28, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
PRIYAN PERERA MD PLLC
Practice address
815 S Vassault St
Tacoma, WA 98465-2008
Phone
(253) 444-3427
NPI assigned
May 15, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 28, 2020

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

Authorized official

Name
Priyan Perera, MDNPI 1629202627
Title
Owner
Phone
(253) 444-3427

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary
Physical Medicine & Rehabilitation PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208100000X

Addresses

Primary practice location

815 S Vassault St
Tacoma, WA 98465-2008

Mailing address

PO Box 66657
Seattle, WA 98166-0657
Phone (206) 453-1818

Other names 1

  • Northwest Rehabilitation Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190709000848 WA Part B Supplier - Clinic/Group Practice 2062747330 Receives reassigned benefits from 1 practitioner
Practice locations: Tacoma, WA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1557878400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1595894400000",
    "number": "1912563982",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 66657",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981660657",
            "telephone_number": "206-453-1818",
            "fax_number": "855-511-5091"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "815 S VASSAULT ST",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984652008",
            "telephone_number": "253-444-3427"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIYAN PERERA MD PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-15",
        "last_updated": "2020-07-28",
        "certification_date": "2020-07-28",
        "status": "A",
        "authorized_official_last_name": "PERERA",
        "authorized_official_first_name": "PRIYAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "253-444-3427",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Northwest Rehabilitation",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Northwest Rehabilitation",
            "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 Jul 28, 2020; 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.

Verify at the official NPI Registry.