North Kitsap Ambulatory Surgery Center, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

600558138 Issued in WA

Legal business name

NORTH KITSAP AMBULATORY SURGERY CENTER, LLC

Practice address

20669 Bond Rd NE
Suite 200
Poulsbo, WA 98370-6525

Phone

(360) 779-6527

Fax

(360) 697-2743

NPI assigned

Jul 26, 2005

Organization subpart

No

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

Authorized official

Name

Jamie Fowler

Title

Chief Administrative Officer

Phone

(360) 779-6527

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Pacific Surgery Center Doing business as

Medicare fee-for-service enrollment

Enrolled in WA2 enrollments

Enrollment records 2

Listed as

North Kitsap Ambulatory Surgery Center IncCCN 50C0001013

Medicare certification status

ActiveFrom the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 2

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

• Michael C Jungkeit, M.D.

  • Specialist
  • Poulsbo, WA
  • NPI 1821170895
  NPD (past)
• Dana Ann Jungschaffer, MD

  • Ophthalmology Physician
  • Bremerton, WA
  • NPI 1649359647
  NPD (past)

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

{
    "created_epoch": "1122336000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1640649600000",
    "number": "1962402503",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20669 BOND RD NE",
            "address_2": "SUITE 200",
            "city": "POULSBO",
            "state": "WA",
            "postal_code": "983706525",
            "telephone_number": "360-779-6527",
            "fax_number": "360-697-2743"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20669 BOND RD NE",
            "address_2": "SUITE 200",
            "city": "POULSBO",
            "state": "WA",
            "postal_code": "983706525",
            "telephone_number": "360-779-6527",
            "fax_number": "360-697-2743"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH KITSAP AMBULATORY SURGERY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-26",
        "last_updated": "2021-12-28",
        "certification_date": "2021-12-28",
        "status": "A",
        "authorized_official_last_name": "FOWLER",
        "authorized_official_first_name": "JAMIE",
        "authorized_official_title_or_position": "CHIEF ADMINISTRATIVE OFFICER",
        "authorized_official_telephone_number": "360-779-6527"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "WA",
            "license": "600558138",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7009293",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pacific Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Pacific Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• NG Russell DDS PC
• Thuy Nguyen
• Kurt David Nielsen, PSYD
• Megan K Nightingale, AUD
• Andrew Glen Noble, O.D.
• North Kitsap Ear Nose & Throat Clinic
• North Kitsap Family Practice and Urgent Care P.S.
• North Kitsap Pediatrics P.S.
• North Kitsap School District
• North Peninsula Chiropractic

• Ambulatory Surgical Clinic/Center in Poulsbo, WA
• Providers in Poulsbo, WA by specialty
• Ambulatory Surgical Clinic/Center in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.