PROVIDENCE PHYSICIAN GROUP (NPI# 1871515429) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1871515429 |
| Entity Type | Organization |
| Organization Name | PROVIDENCE PHYSICIAN GROUP |
| Practice Address |
1330 Rockefeller Ave Suite 230 Everett WA 98201-1684 |
| Mailing Address |
909 N Broadway Pbo/credentialing Everett WA 98201-1409 |
| Practice Telephone | 4252614925 |
| Practice Fax Number | 4252614932 |
| Mailing Telephone | 4253170246 |
| Mailing Fax Number | 4253170291 |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2010-03-11 |
| Authorized Official Name | MS. BARBARA SCHUMACHER (PRO FEE CREDENTIALING MANAGER) |
| Authorized Official Telephone | 4252614925 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2471B0102X |
Radiologic Technologist Specialization: Bone Densitometry |
Technologists, Technicians & Other Technical Service Providers | ||
| N | 332B00000X | Durable Medical Equipment & Medical Supplies | Suppliers | ||
| N | 363LG0600X |
Nurse Practitioner Specialization: Gerontology |
Physician Assistants & Advanced Practice Nursing Providers | ||
| Y | 207R00000X | Internal Medicine | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WA | 7095417 | 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 |
| 1225119050 | Providence Physician Group | Internal Medicine | 5007 Claremont Way, Everett, WA 98203-3321 | 2006-10-18 |
| Street Address |
1330 ROCKEFELLER AVE SUITE 230 |
| City | EVERETT |
| State | WA |
| Zip Code | 98201-1684 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366435943 | John F Matista | Physician Assistant | 1330 Rockefeller Ave, Suite 225, Everett, WA 98201-1684 | 2005-08-29 |
| 1326598715 | Providence Regional Medical Center | Clinic/Center | 1330 Rockefeller Ave, Suite 150 Medical Offfic Building, Everett, WA 98201-1684 | 2016-10-10 |
| 1861940504 | Lindsay Cook Mertz | Physician Assistant | 1330 Rockefeller Ave, Suite 310, Everett, WA 98201-1684 | 2016-09-12 |
| 1437524352 | John Gavareski | Physician Assistant | 1330 Rockefeller Ave, Everett, WA 98201-1684 | 2015-12-03 |
| 1700261120 | Anna Chan | Pharmacist | 1330 Rockefeller Ave, Suite 150, Everett, WA 98201-1684 | 2015-07-27 |
| 1588051494 | Luis Fernando Alberton | Surgery | 1330 Rockefeller Ave, Ste 400, Everett, WA 98201-1684 | 2015-04-17 |
| 1205222551 | Patrick Willauer | Surgery | 1330 Rockefeller Ave, Everett, WA 98201-1684 | 2015-04-14 |
| 1538554761 | Patrick M Haugstad | Pharmacist | 1330 Rockefeller Ave, Suite 150, Everett, WA 98201-1684 | 2015-04-03 |
| 1770972481 | Lisa Mccabe | Nurse Practitioner | 1330 Rockefeller Ave, Suite 310, Everett, WA 98201-1684 | 2015-01-19 |
| 1851798714 | Emily Rockwell Williamson | Pharmacist | 1330 Rockefeller Ave, Suite 150, Everett, WA 98201 | 2014-11-20 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306471867 | Shannon Michelle Dewald | Registered Nurse | D8s 1700 13th St, Everett, WA 98201 | 2020-03-05 |
| 1578123113 | Precious Medicial Spa, LLC | Registered Nurse | 1728 W. Marine View Dr Suite 212, Everett, WA 98201 | 2019-06-17 |
| 1508429796 | Alix Deschain | Counselor | 2801 Broadway, Everett, WA 98201 | 2019-04-15 |
| 1811457534 | Khushboo Patel | Pharmacist | 1330 Rockefeller Ave Ste 150, Everett, WA 98201 | 2019-03-20 |
| 1164991188 | Grace Talbot Davis | Registered Nurse | 2601 Summit Avenue, Bldg. C, Everett, WA 98201 | 2018-11-20 |
| 1063924603 | Tracy Sisk | Counselor | 3120 Colby Ave, 502, Everett, WA 98201 | 2017-11-03 |
| 1710403126 | Michelle Durham | Counselor | 3322 Boadway Fl 2, Everett, WA 98201 | 2017-08-17 |
| 1861927949 | Melanie Schmidt | Counselor | 2610 Westmore Ave, Everett, WA 98201 | 2017-04-26 |
| 1518413327 | Joseph Madson Dmd Pllc | Clinic/Center | 3802 Colby Ave, 4th Floor, Everett, WA 98201 | 2016-08-31 |
| 1043683162 | Jennifer Adams | Counselor | 1511 26th St, Everett, WA 98201 | 2015-11-11 |
| Find all providers in zip 98201 | ||||
| Taxonomy Code | 207R00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| 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. |
| 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 |
| 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.