PROVIDENCE PHYSICIAN GROUP


Address: 12800 Bothell Everett Hwy, Suite 180, Everett, WA 98208-6642
Phone: 4253165130

PROVIDENCE PHYSICIAN GROUP (NPI# 1619050580) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1619050580
Entity Type Organization
Organization Name PROVIDENCE PHYSICIAN GROUP
Practice Address 12800 Bothell Everett Hwy
Suite 180
Everett
WA 98208-6642
Mailing Address 909 N Broadway
Pbo/credentialing
Everett
WA 98201-1409
Practice Telephone 4253165130
Practice Fax Number 4253165131
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 4253165130
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
N 332B00000X Durable Medical Equipment & Medical Supplies Suppliers
Y 207R00000X Internal Medicine Allopathic & Osteopathic Physicians

Other Provider Identifier

State Issuer Identifier Type Code
WA 7095292 05

Other Provider IDs and Locations

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
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
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

Office Location

Street Address 12800 BOTHELL EVERETT HWY
SUITE 180
City EVERETT
State WA
Zip Code 98208-6642

Providers in the same location

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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Providers in the same zip code

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
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Taxonomy Information

Taxonomy Code 207R00000X
Grouping Allopathic & Osteopathic Physicians
Classification Internal Medicine

Taxonomy Definition

A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.
Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source]
- Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification
- Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1902223365 Amy Vannortwick Internal Medicine 1321 Colby Ave Ofc, Everett, WA 98201-1665 2014-03-24
1174889075 Summit Cardiology Ps Internal Medicine 1800 13th Street, Everett, WA 98201 2012-04-04
1851684856 Jocelyn Ronda Internal Medicine Mgh Everett Family Care, 19 Norwood St, Everett, MA 02149 2011-05-24
1801113154 Niket Nathani Internal Medicine 12728 19th Ave Se Ste 300, Everett, WA 98208 2010-04-27
1871787663 Justin R. Cuschieri Internal Medicine 4225 Hoyt Avenue, Ste A, Everett, WA 98203-2318 2007-09-05
1649462102 Bhawna Gupta Internal Medicine 1330 Rockefeller Ave Ste 210, Everett, WA 98201-1676 2007-08-17
1881899011 Conrad Jablonski Internal Medicine 3901 Hoyt Avenue, Founders Building, Everett, WA 98201 2007-06-18
1376660472 Leigh R. Anderson Internal Medicine 12728 19th Ave Se Ste 200, Everett, WA 98208 2007-03-23
1225100373 Frederick C Manning Internal Medicine 4005 Hoyt Ave, Everett, WA 98201-4920 2006-11-14
1144318056 Wayne Crawford Draper Internal Medicine 135 Santilli Highway, Suite 310, Everett, MA 02149-1906 2006-10-10
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Competitor

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City EVERETT
Zip Code 98208

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Dataset Information

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.

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