Franciscan Medical Group

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

FRANCISCAN MEDICAL GROUP

Doing business as

Surprise Lake Medical Clinic

Practice address

2748 Milton Way
Ste 101
Milton, WA 98354-9382

Phone

(253) 922-5262

Fax

(253) 922-5299

NPI assigned

Jul 30, 2006

Last updated

Jun 14, 2010By the provider in NPPES

Organization subpart

Yes

Parent organization

FRANCISCAN MEDICAL GROUPAs reported in NPPES

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

Authorized official

Name

Cliff Robertson

Title

Chief Medical Officer

Phone

(253) 779-6101

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Surprise Lake Medical Clinic Doing business as

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

Part of

CHI Franciscan Health

Practitioners 1

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.

• Eugene Syn Cho, MD

  • Surgery Physician
  • Tacoma, WA
  • NPI 1851301568
  NPD

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

{
    "created_epoch": "1154217600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1276473600000",
    "number": "1962417659",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2748 MILTON WAY",
            "address_2": "STE 101",
            "city": "MILTON",
            "state": "WA",
            "postal_code": "983549382",
            "telephone_number": "253-922-5262",
            "fax_number": "253-922-5299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2748 MILTON WAY",
            "address_2": "STE 101",
            "city": "MILTON",
            "state": "WA",
            "postal_code": "983549382",
            "telephone_number": "253-922-5262",
            "fax_number": "253-922-5299"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FRANCISCAN MEDICAL GROUP",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FRANCISCAN MEDICAL GROUP",
        "enumeration_date": "2006-07-30",
        "last_updated": "2010-06-14",
        "status": "A",
        "authorized_official_last_name": "ROBERTSON",
        "authorized_official_first_name": "CLIFF",
        "authorized_official_title_or_position": "CHIEF MEDICAL OFFICER",
        "authorized_official_telephone_number": "253-779-6101"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE L&I",
            "identifier": "0105765",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7124365",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Surprise Lake Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Varina Duffy, COTA/L
• Donna Edwards
• Kimberly A Edwards, LMP
• Sherilyn Ann Finlayson, AAC
• Jacqueline Ford
• Elizabeth Caroline Freeman, LMP
• Susan Fualaau
• Lilia Galanesi, ARNP
• Stevie Elizabeth Gipson, RN
• Sandra Gobler

• Family Medicine Physician in Milton, WA
• Providers in Milton, WA by specialty
• Family Medicine Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2010; 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.