PROVIDENCE PHYSICIAN GROUP (NPI# 1225119050) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1225119050 |
| Entity Type | Organization |
| Organization Name | PROVIDENCE PHYSICIAN GROUP |
| Practice Address |
5007 Claremont Way Everett WA 98203-3321 |
| Mailing Address |
909 N Broadway Pbo/credentialing Everett WA 98201-1409 |
| Practice Telephone | 4252587050 |
| Practice Fax Number | 4252587055 |
| Mailing Telephone | 4253170246 |
| Mailing Fax Number | 4253170291 |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2010-03-11 |
| Authorized Official Name | MS. BARBARA SCHUMACHER (PRO FEE CREDENTIALING MANAGER) |
| Authorized Official Telephone | 4252587050 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207R00000X | Internal Medicine | Allopathic & Osteopathic Physicians | ||
| N | 208000000X | Pediatrics | Allopathic & Osteopathic Physicians | ||
| N | 332B00000X | Durable Medical Equipment & Medical Supplies | Suppliers | ||
| Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WA | 7095300 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932270360 | Providence Physician Group | Dermatology | 12800 Bothell Everett Hwy, Suite 260, Everett, WA 98208-6642 | 2006-11-09 |
| 1639258130 | Providence Physician Group | Clinic/Center | 12800 Bothell Everett Hwy, Suite 120, Everett, WA 98208-6642 | 2006-11-03 |
| 1073699922 | Providence Physician Group | Neurological Surgery | 2320 Rucker Ave, Suite A, Everett, WA 98201-2723 | 2006-10-31 |
| 1518040484 | Providence Physician Group | Radiologic Technologist | 14692 179th Ave Se, Suite 100, Monroe, WA 98272-1198 | 2006-10-23 |
| 1972686848 | Providence Physician Group | Durable Medical Equipment & Medical Supplies | 14692 179th Ave Se, Suite 800, Monroe, WA 98272-1198 | 2006-10-23 |
| 1699858563 | Providence Physician Group | Durable Medical Equipment & Medical Supplies | 1330 Rockefeller Ave, Suite 220, Everett, WA 98201-1684 | 2006-10-23 |
| 1619050580 | Providence Physician Group | Durable Medical Equipment & Medical Supplies | 12800 Bothell Everett Hwy, Suite 180, Everett, WA 98208-6642 | 2006-10-23 |
| 1528141496 | Providence Physician Group | Durable Medical Equipment & Medical Supplies | 12800 Bothell Everett Hwy, Suite 190, Everett, WA 98208-6642 | 2006-10-23 |
| 1093896854 | Providence Physician Group | Radiologic Technologist | 12800 Bothell Everett Hwy, Suite 160, Everett, WA 98208-6644 | 2006-10-18 |
| 1548282189 | Providence Physician Group | Durable Medical Equipment & Medical Supplies | 14692 179th Ave Se, Suite 900, Monroe, WA 98272-1198 | 2006-07-24 |
| Street Address |
5007 CLAREMONT WAY |
| City | EVERETT |
| State | WA |
| Zip Code | 98203-3321 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376644518 | Thomas G. Pautler | Family Medicine | 5007 Claremont Way, Everett, WA 98203-3321 | 2006-09-26 |
| 1629678727 | Linda Oh | Counselor | 5007 Claremont Way, Everett, WA 98203-3321 | 2020-10-28 |
| 1679187009 | Sarah Nicole Fletcher | Counselor | 5007 Claremont Way, Everett, WA 98203-3321 | 2020-09-02 |
| 1235778408 | Jing Nian | Counselor | 5007 Claremont Way, Everett, WA 98203-3321 | 2020-01-05 |
| 1952961856 | Mary Jo Alejo | Counselor | 5007 Claremont Way, Everett, WA 98203-3321 | 2019-06-13 |
| 1134787237 | Emily Elizabeth Hansen | Counselor | 5007 Claremont Way, Everett, WA 98203-3321 | 2019-06-03 |
| 1487118055 | Mallory Jean Douge | Counselor | 5007 Claremont Way, Everett, WA 98203-3321 | 2019-01-28 |
| 1467930487 | Patricia Wright | Counselor | 5007 Claremont Way, Everett, WA 98203-3321 | 2018-08-01 |
| 1902316656 | Angelica Dianne Nevarez | Counselor | 5007 Claremont Way, Everett, WA 98203-3321 | 2017-10-09 |
| 1952829483 | Eleonora Prikhodko | Counselor | 5007 Claremont Way, Everett, WA 98203-3321 | 2017-09-05 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083226039 | Lisa Mcgregor | Counselor | Sea Mar Community Health Centers, 5007 Claremont Way, Everett, WA 98203 | 2020-08-20 |
| 1417572009 | Megan Ostermick-durkee | Student in an Organized Health Care Education/Training Program | Sunrise Services Inc., 811 Madison Street, Everett, WA 98203 | 2020-06-10 |
| 1134741424 | Tara Lin Garcia | Peer Specialist | 4256 Federal Avenue, Everett, WA 98203 | 2020-05-11 |
| 1225505241 | Reverie Aurora Shunny | Counselor | Sunrise Service Inc., 811 Madison Street, Everett, WA 98203 | 2018-10-29 |
| 1205313483 | Kristina Renee Bylenga | Counselor | Compass Health 4526 Federal Avenue M/s # 11, Everett, WA 98203 | 2018-07-20 |
| 1306384300 | Shantijoy Inc | Naturopath | 5208 S 2nd Ave, Everett, WA 98203 | 2017-02-09 |
| 1922545276 | Ekaterina Malinovska Dds Pllc | Dentist | 5920 Evergreen Way Suite E, Everett, WA 98203 | 2017-01-25 |
| 1326404104 | Job Oichoe | Counselor | 4625 Federal Ave, Everett, WA 98203 | 2016-01-08 |
| 1427423292 | Ross Lee Voorhees | Counselor | 4423 S 3rd Ave, Everett, WA 98203 | 2015-12-04 |
| 1447642376 | Adam Schneider | Counselor | 4526 Federal Ave # 40, Everett, WA 98203 | 2015-03-02 |
| Find all providers in zip 98203 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649882275 | Blair Regenerative Medicine LLC | Family Medicine | 201 Hospital Dr Ste 2, Everett, PA 15537-7019 | 2020-08-17 |
| 1366856569 | Bowhee Sohn Gwak | Family Medicine | 12800 Bothell Everett Hwy Ste 160, Everett, WA 98208-6644 | 2014-06-16 |
| 1518392513 | Bernadette Flynn | Family Medicine | 41 W 1st St, Everett, PA 15537-1103 | 2013-09-09 |
| 1801164058 | Charles William Starbuck | Family Medicine | 3605 Shore Avenue, Everett, WA 98203-1209 | 2011-12-02 |
| 1649498049 | Western Washington Medical Group, Inc Ps | Family Medicine | 4225 Hoyt Ave Ste B, Everett, WA 98203-2351 | 2007-04-23 |
| 1689790792 | Del Whetstone | Family Medicine | 9629 Evergreen Way, Suite 102, Everett, WA 98204-7198 | 2007-03-21 |
| 1497843213 | Vincent M. Koike | Family Medicine | 7601 Evergreen Way, B-6, Everett, WA 98203 | 2006-10-10 |
| 1295820942 | North Creek Medicine Inc P S | Family Medicine | 210 128th St Se, Everett, WA 98208-6338 | 2006-10-04 |
| 1376644518 | Thomas G. Pautler | Family Medicine | 5007 Claremont Way, Everett, WA 98203-3321 | 2006-09-26 |
| 1487662581 | Allison M Cole | Family Medicine | 1410 Broadway, Everett, WA 98201-1720 | 2006-08-04 |
| Find all providers in EVERETT | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.