NPIMap

Organization Active NPI

Washington Pain and Spine Specialists LLC

  • Pain Clinic/Center
  • Olympia, WA
National Provider Identifier
1992486906
Registry record updated Jul 31, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Clinic/CenterTaxonomy code 261QP3300X
Legal business name
WASHINGTON PAIN AND SPINE SPECIALISTS LLC
Practice address
3525 Ensign Rd NE Ste J
Olympia, WA 98506-5065
Phone
(240) 463-4101
NPI assigned
Jul 31, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 31, 2023

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

Authorized official

Name
Dr. Praveen Kumar Mambalam, MDNPI 1790942886
Title
Owner
Phone
(240) 463-4101

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
Pain Clinic/Center 261QP3300X Primary

Addresses

Primary practice location

3525 Ensign Rd NE Ste J
Olympia, WA 98506-5065

Mailing address

4957 Lakemont Blvd SE Ste C-425
Bellevue, WA 98006-7801
Phone (240) 463-4101

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240214003694 WA Part B Supplier - Clinic/Group Practice 7315381639 Receives reassigned benefits from 9 practitioners
Practice locations: Vancouver, WA; Everett, WA; Tukwila, WA; Tacoma, WA; Seattle, WA; Olympia, WA; Lynnwood, WA

National Provider Directory

National Provider Directory

Locations

4957 Lakemont Blvd SE
Ste C425
Bellevue, WA 98006

3202 Colby Ave
Ste B
Everett, WA 98201
Phone (206) 895-1825

155 Lilly Rd NE
Ste A
Olympia, WA 98506
Phone (206) 895-1825

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/IJBDDD

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": "1690761600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1690761600000",
    "number": "1992486906",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4957 LAKEMONT BLVD SE STE C-425",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980067801",
            "telephone_number": "240-463-4101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3525 ENSIGN RD NE STE J",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985065065",
            "telephone_number": "240-463-4101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WASHINGTON PAIN AND SPINE SPECIALISTS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-07-31",
        "last_updated": "2023-07-31",
        "certification_date": "2023-07-31",
        "status": "A",
        "authorized_official_last_name": "MAMBALAM",
        "authorized_official_first_name": "PRAVEEN",
        "authorized_official_middle_name": "KUMAR",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "240-463-4101",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP3300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Pain",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Olympia, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 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.