The Eastside Endoscopy Center LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

THE EASTSIDE ENDOSCOPY CENTER LLC

Practice address

1135 116TH Ave NE
Suite 570
Bellevue, WA 98004-4623

Phone

(425) 451-7335

Fax

(425) 451-1226

NPI assigned

Jun 30, 2005

Last updated

Mar 7, 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

Nicolas Goralsky

Title

Coo

Phone

(253) 383-8342

Specialties & licenses 1

Addresses

Other identifiers 5

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).

• The Eastside Endoscopy Center, LLC

  • Ambulatory Surgical Clinic/Center
  • Issaquah, WA
  • NPI 1679858849

  9032006044

  Same PAC ID

Listed as

Eastside Endoscopy Center PLLCCCN 50C0001093

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

Tax ID family

Eastside Endoscopy Center2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• The Eastside Endoscopy Center, LLC

  • Ambulatory Surgical Clinic/Center
  • Issaquah, WA
  • NPI 1679858849
  NPD tax ID

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Washington Gastroenterology PLLC

  • Clinical Medical Laboratory
  • Federal Way, WA
  • NPI 1245265826

  Member Of

  NPD member

Locations

Practitioners 2

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.

• Nicholas J Procaccini, MD

  • Gastroenterology Physician
  • Seattle, WA
  • NPI 1336351147
  NPD (past)
• Aparna P. Kulkarni, MD

  • Gastroenterology Physician
  • Houston, TX
  • NPI 1912996679
  NPD (past)

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

{
    "created_epoch": "1120089600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1992702443",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1135 116TH AVE NE",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980044623",
            "telephone_number": "425-544-7684",
            "fax_number": "425-462-8021"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1135 116TH AVE NE",
            "address_2": "SUITE 570",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980044623",
            "telephone_number": "425-451-7335",
            "fax_number": "425-451-1226"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE EASTSIDE ENDOSCOPY CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-30",
        "last_updated": "2023-03-07",
        "status": "A",
        "authorized_official_last_name": "GORALSKY",
        "authorized_official_first_name": "NICOLAS",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "253-383-8342"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7067366",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA NUMBER",
            "identifier": "50D0923026",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AAAHC ACCREDITATION",
            "identifier": "15949",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE BS",
            "identifier": "EA0308",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "MTS-3102",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Ambulatory Surgical Clinic/Center in Bellevue, WA
• Providers in Bellevue, 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 Mar 7, 2023; 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.