PROVIDENCE PHYSICIAN GROUP (NPI# 1528141496) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1528141496 |
| Entity Type | Organization |
| Organization Name | PROVIDENCE PHYSICIAN GROUP |
| Practice Address |
12800 Bothell Everett Hwy Suite 190 Everett WA 98208-6642 |
| Mailing Address |
909 N Broadway Pbo/credentialing Everett WA 98201-1409 |
| Practice Telephone | 4253165160 |
| Practice Fax Number | 4253165163 |
| Mailing Telephone | 4253170246 |
| Mailing Fax Number | 4253170291 |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2010-03-11 |
| Authorized Official Name | MS. BARBARA SCHUMACHER (PRO FEE CREDENTIALING MANAGER) |
| Authorized Official Telephone | 4253165160 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 332B00000X | Durable Medical Equipment & Medical Supplies | Suppliers | ||
| Y | 208000000X | Pediatrics | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WA | 7095318 | 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 |
| 1093896854 | Providence Physician Group | Radiologic Technologist | 12800 Bothell Everett Hwy, Suite 160, Everett, WA 98208-6644 | 2006-10-18 |
| 1225119050 | Providence Physician Group | Internal Medicine | 5007 Claremont Way, Everett, WA 98203-3321 | 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 |
12800 BOTHELL EVERETT HWY SUITE 190 |
| City | EVERETT |
| State | WA |
| Zip Code | 98208-6642 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518963404 | James Daniel Bass | Family Medicine | 12800 Bothell Everett Hwy, Everett, WA 98208-6642 | 2005-06-24 |
| 1437620499 | Laboratory Corporation of America | Clinical Medical Laboratory | 12800 Bothell Everett Hwy, Everett, WA 98208-6642 | 2018-12-16 |
| 1306375563 | Coreyanne L Griffin | Counselor | 12800 Bothell Everett Hwy, Everett, WA 98208-6642 | 2017-06-09 |
| 1407389448 | Bushra Rahman | Internal Medicine | 12800 Bothell Everett Hwy, Everett, WA 98208-6642 | 2017-04-06 |
| 1831639731 | Providence Health & Services | Home Health Aide | 12800 Bothell Everett Hwy, Suite 290, Everett, WA 98208-6642 | 2017-02-27 |
| 1700325826 | Caroline Judd | Social Worker | 12800 Bothell Everett Hwy, Everett, WA 98208-6642 | 2017-02-22 |
| 1225485550 | Amy Barrows | Nurse Practitioner | 12800 Bothell Everett Hwy, Suite 120, Everett, WA 98208-6642 | 2016-05-17 |
| 1104299601 | Gary Dale Montgomery | Physician Assistant | 12800 Bothell Everett Hwy, Ste A, Everett, WA 98208-6642 | 2015-11-05 |
| 1457731556 | Laura Knapp | Counselor | 12800 Bothell Everett Hwy, Suite 290, Everett, WA 98208-6642 | 2015-06-03 |
| 1174903603 | Justin Gill | Nurse Practitioner | 12800 Bothell Everett Hwy, Everett, WA 98208 | 2015-05-29 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790270296 | Kenneth Britt Dyer | Registered Nurse | 10333 19th Ave, Se, Ste #109, Everett, WA 98208 | 2018-06-27 |
| 1518482215 | Glacier Peak Healthcare, Inc. | Home Health | 10530 19th Ave Se Ste 201, Everett, WA 98208 | 2017-08-03 |
| 1114454865 | Aliza Kreisman | Registered Nurse | 11020 19th Avenue Se, Kaiser Permanente of Washington Seattle Care Clinic, Everett, WA 98208 | 2017-05-12 |
| 1902269418 | Clay Eakin | Counselor | 2732 Grand Evenue, Everett, WA 98208 | 2016-04-01 |
| 1467810259 | Elizabeth Anne Powley | Marriage & Family Therapist | 1920 100th Street Southeast, Bld C3, Everett, WA 98208 | 2016-02-08 |
| 1659745842 | Andrea Rose Bedlington | Pharmacist | 11407 33rd Dr. Se, Everett, WA 98208 | 2015-11-25 |
| 1396123865 | Sound Surgeons Pllc | Clinic/Center | 125 130th Street Se, 1st Floor, Everett, WA 98208 | 2015-05-15 |
| 1831576537 | Chris Sturgeon | Counselor | 10102 Meridian Ave, Everett, WA 98208 | 2015-05-01 |
| 1982011128 | James M Lee | Physical Therapist | 10821 19th Ave Se Ste 102, Everett, WA 98208 | 2014-07-21 |
| 1972937357 | Ronald Tracy | Dentist | 10315 19th Avenue Se Suite 110, Everett, WA 98208 | 2013-08-21 |
| Find all providers in zip 98208 | ||||
| Taxonomy Code | 208000000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certificatio - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649789595 | Mark Edward Beatty | Pediatrics | 3020 Rucker Ave Ste 306, Everett, WA 98201-3900 | 2017-09-22 |
| 1366804510 | Arsany Basily | Pediatrics | 1815 13th St, Everett, WA 98201-1679 | 2016-03-27 |
| 1548691785 | Children's Community Care | Pediatrics | 249 Hospital Dr Lowr Level, Everett, PA 15537-7020 | 2013-12-12 |
| 1912235060 | Molina Healthcare of Washington, Inc | Pediatrics | 3322 Broadway, Suite 200, Everett, WA 98201-4425 | 2009-12-01 |
| 1689700155 | Upmc Community Medicine Inc | Pediatrics | 14 E 3rd Ave, Everett, PA 15537-1305 | 2007-02-26 |
| 1164479002 | Peter E Masucci, Md, PC | Pediatrics | 391 Broadway, Suite 301, Everett, MA 02149-3470 | 2006-05-27 |
| 1598753733 | Yvonne Qing Ma | Pediatrics | 1019 112th St Sw, Everett, WA 98204-4875 | 2005-10-12 |
| 1649665829 | Elizabeth Abernathey | Pediatrics | 3901 Hoyt Ave, Everett, WA 98201-4918 | 2015-04-03 |
| 1366861494 | Rachel Skalina | Pediatrics | 1424 Broadway, Everett, WA 98201-1720 | 2014-04-16 |
| 1730507393 | Sarah Louise Pinney | Pediatrics | 1818 121st St Se, Everett, WA 98208-5985 | 2014-04-01 |
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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.