NPIMap

Organization Active NPI

Columbia Medical PLLC

  • Allergy & Immunology Physician
  • Longview, WA
National Provider Identifier
1962265900
Registry record updated Nov 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Allergy & Immunology PhysicianTaxonomy code 207K00000X
Legal business name
COLUMBIA MEDICAL PLLC
Practice address
1152 Douglas St
Longview, WA 98632-2452
Phone
(360) 940-0880
Fax
(844) 697-8702
NPI assigned
Feb 1, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 26, 2024

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

Authorized official

Name
Sanjeev Jain, MDNPI 1710973839
Title
Owner/Ceo
Phone
(408) 476-0624

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Allergy & Immunology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207K00000X Primary

Addresses

Primary practice location

1152 Douglas St
Longview, WA 98632-2452

Mailing address

43575 Mission Blvd Ste 716
Fremont, CA 94539-5831
Phone (510) 373-3000

Other names 1

  • Columbia Allergy Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240502004113 WA Part B Supplier - Clinic/Group Practice 0840630109 Receives reassigned benefits from 8 practitioners
Practice locations: Bellevue, WA; Longview, WA; Vancouver, WA

National Provider Directory

National Provider Directory

Locations

1152 Douglas St
Longview, WA 98632
Phone (360) 423-1113

4317 NE Thurston Way
Ste 100
Vancouver, WA 98662
Phone (360) 940-0810

Practitioners & affiliated clinicians

Practitioners 9

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": "1706745600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1732579200000",
    "number": "1962265900",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "43575 MISSION BLVD STE 716",
            "city": "FREMONT",
            "state": "CA",
            "postal_code": "945395831",
            "telephone_number": "510-373-3000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1152 DOUGLAS ST",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "986322452",
            "telephone_number": "360-940-0880",
            "fax_number": "844-697-8702"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLUMBIA MEDICAL PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-02-01",
        "last_updated": "2024-11-26",
        "certification_date": "2024-11-26",
        "status": "A",
        "authorized_official_last_name": "JAIN",
        "authorized_official_first_name": "SANJEEV",
        "authorized_official_title_or_position": "OWNER/CEO",
        "authorized_official_telephone_number": "408-476-0624",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207K00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Allergy & Immunology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Columbia Allergy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Columbia Allergy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Longview, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2024; 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.