NPIMap

Organization Active NPI

Puget Sound Gastroenterology, PLLC

  • Gastroenterology Physician
  • Mill Creek, WA
National Provider Identifier
1912929738
Registry record updated May 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
Legal business name
PUGET SOUND GASTROENTEROLOGY, PLLC
Practice address
16504 9TH Ave SE
Suite 106
Mill Creek, WA 98012-6388
Phone
(425) 977-4620
Fax
(425) 745-9836
NPI assigned
Jul 24, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 16, 2025

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

Authorized official

Name
Alan Oliver, CEO
Title
Ceo
Phone
(786) 530-3820

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RG0100X Primary

Addresses

Primary practice location

16504 9TH Ave SE
Suite 106
Mill Creek, WA 98012-6388

Mailing address

16504 9TH Ave SE
Suite 106
Mill Creek, WA 98012-6388
Phone (425) 977-4620

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040301000478 WA Part B Supplier - Clinic/Group Practice 1759278252 Receives reassigned benefits from 95 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Edmonds, WA; Seattle, WA; Olympia, WA; Mill Creek, WA; Lynnwood, WA; Kirkland, WA; Kennewick, WA; Everett, WA

Other NPIs on the same Medicare enrollment 6

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

National Provider Directory

National Provider Directory
Tax ID family
Sea Gastroenterology As4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1153699200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747353600000",
    "number": "1912929738",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16504 9TH AVE SE",
            "address_2": "SUITE 106",
            "city": "MILL CREEK",
            "state": "WA",
            "postal_code": "980126388",
            "telephone_number": "425-977-4620",
            "fax_number": "425-745-9836"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16504 9TH AVE SE",
            "address_2": "SUITE 106",
            "city": "MILL CREEK",
            "state": "WA",
            "postal_code": "980126388",
            "telephone_number": "425-977-4620",
            "fax_number": "425-745-9836"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PUGET SOUND GASTROENTEROLOGY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-24",
        "last_updated": "2025-05-16",
        "certification_date": "2025-05-16",
        "status": "A",
        "authorized_official_last_name": "OLIVER",
        "authorized_official_first_name": "ALAN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "786-530-3820",
        "authorized_official_credential": "CEO"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mill Creek, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2025; 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.