NPIMap

Organization Active NPI

Western Washington Medical Group Inc PS

  • Cardiovascular Disease Physician
  • Everett, WA
National Provider Identifier
1982551867
Registry record updated Apr 17, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
Legal business name
WESTERN WASHINGTON MEDICAL GROUP INC PS
Practice address
12728 19TH Ave SE Ste 200
Everett, WA 98208-6676
Phone
(425) 225-2700
Fax
(425) 225-2790
NPI assigned
Mar 11, 2026
Organization subpart
Yes
Parent organization
WESTERN WASHINGTON MEDICAL GROUP, INC PSAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 17, 2026

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

Authorized official

Name
David Russian, MD
Title
Ceo
Phone
(425) 259-4041

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RC0000X Primary
Interventional Cardiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RI0011X

Addresses

Primary practice location

12728 19TH Ave SE Ste 200
Everett, WA 98208-6676

Mailing address

1728 W Marine View Dr Ste 110
Everett, WA 98201-2094
Phone (425) 259-4041

Other names 1

  • Western Washington Medical Group Department of Cardiology Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031107000469 WA Part B Supplier - Clinic/Group Practice 7517870314 Receives reassigned benefits from 130 practitioners
32 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Everett, WA; Lynnwood, WA; Marysville, WA; Monroe, WA; Oak Harbor, WA; Snohomish, WA; Anacortes, WA; Arlington, WA…

Other NPIs on the same Medicare enrollment 32

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

View all 32

National Provider Directory

National Provider Directory
Tax ID family
Western Washington Med GRP21 organizations share this tax ID, including this one
Part of
Western Washington Med GRP

Other organizations with this tax ID 20

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

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1773187200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1776384000000",
    "number": "1982551867",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1728 W MARINE VIEW DR STE 110",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982012094",
            "telephone_number": "425-259-4041",
            "fax_number": "425-225-2790"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12728 19TH AVE SE STE 200",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982086676",
            "telephone_number": "425-225-2700",
            "fax_number": "425-225-2790"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WESTERN WASHINGTON MEDICAL GROUP INC PS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WESTERN WASHINGTON MEDICAL GROUP, INC PS",
        "enumeration_date": "2026-03-11",
        "last_updated": "2026-04-17",
        "certification_date": "2026-04-17",
        "status": "A",
        "authorized_official_last_name": "RUSSIAN",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "425-259-4041",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Western Washington Medical Group Department of Cardiology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Everett, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2026; 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.