Peacehealth

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

PEACEHEALTH

Doing business as

Peacehealth Medical Group-Optical Shop Vancouver Network

Practice address

505 NE 87TH Ave Ste 100
Vancouver, WA 98664-4801

Phone

(360) 904-6781

Fax

(360) 859-3173

NPI assigned

May 5, 2015

Last updated

Apr 27, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Doug Watson

Title

Cfo

Phone

(360) 729-1718

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• PEACEHEALTH MEDICAL GROUP-OPTICAL SHOP VANCOUVER NETWORK Doing business as

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Peacehealth

  dba PeaceHealth Medical Group

  • Surgery Physician
  • Vancouver, WA
  • NPI 1609061969

  8820178288

  Same PAC ID

Locations

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.

• Monika Svaricek

  • Massage Therapist
  • Camas, WA
  • NPI 1164663472
  NPD

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

{
    "created_epoch": "1430784000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1682553600000",
    "number": "1992182380",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1115 SE 164TH AVE DEPT 358",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986838004",
            "telephone_number": "360-729-1412"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "505 NE 87TH AVE STE 100",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986644801",
            "telephone_number": "360-904-6781",
            "fax_number": "360-859-3173"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEACEHEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-05",
        "last_updated": "2023-04-27",
        "certification_date": "2023-04-27",
        "status": "A",
        "authorized_official_last_name": "WATSON",
        "authorized_official_first_name": "DOUG",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "360-729-1718"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7140890",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PEACEHEALTH MEDICAL GROUP-OPTICAL SHOP VANCOUVER NETWORK",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "PEACEHEALTH MEDICAL GROUP-OPTICAL SHOP VANCOUVER NETWORK",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Peacehealth (PeaceHealth Southwest Inpatient Rehabilitation)
• Peacehealth (Peacehealth Southwest Hospice)
• Peacehealth (PeaceHealth Southwest Pharmacy at Medical Center)
• Peacehealth (PeaceHealth Medical Group)
• Peacehealth
• Peacehealth Networks on Demand, LLC (ZoomCare- The Mill)
• Peacehealth Networks on Demand, LLC (ZoomCare- Vancouver Waterfront)
• Peacehealth Networks on Demand, LLC (ZoomCare- Salmon Creek)
• Peacehealth Networks on Demand, LLC (ZoomCare- Mill Plain)
• Peacehealth Networks on Demand, LLC (ZoomCare - Grand Central)

• Durable Medical Equipment & Medical Supplies in Vancouver, WA
• Providers in Vancouver, WA by specialty
• Durable Medical Equipment & Medical Supplies in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2023; 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.