PROVIDENCE PHYSICIAN GROUP (NPI# 1972686848) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1972686848 |
| Entity Type | Organization |
| Organization Name | PROVIDENCE PHYSICIAN GROUP |
| Practice Address |
14692 179th Ave Se Suite 800 Monroe WA 98272-1198 |
| Mailing Address |
909 N Broadway Pbo/credentialing Everett WA 98201-1409 |
| Practice Telephone | 3607947994 |
| Practice Fax Number | 3608054757 |
| 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 | 3607947994 |
| 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 | 7096183 | 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 |
| 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 |
| 1548282189 | Providence Physician Group | Durable Medical Equipment & Medical Supplies | 14692 179th Ave Se, Suite 900, Monroe, WA 98272-1198 | 2006-07-24 |
| Street Address |
14692 179TH AVE SE SUITE 800 |
| City | MONROE |
| State | WA |
| Zip Code | 98272-1198 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952342974 | Paul W Boone Jr. | Family Medicine | 14692 179th Ave Se, Suite 500, Monroe, WA 98272-1198 | 2006-06-09 |
| 1215225099 | Providence Health & Services-wa | Midwife | 14692 179th Ave Se, Ste 800, Monroe, WA 98272-1162 | 2011-07-14 |
| 1447547658 | Providence Health & Services-wa | Registered Nurse | 14692 179th Ave Se, Ste 800, Monroe, WA 98272-1162 | 2011-07-08 |
| 1720391758 | Carmela Batallones Andrada | Pharmacist | 14692 179th Ave Se, Monroe, WA 98272-1198 | 2010-07-20 |
| 1902139959 | Priscilla Grace Navaja | Pharmacist | 14692 179th Ave Se, Suite 200, Monroe, WA 98272-1198 | 2009-09-09 |
| 1427282250 | Melissa Dawn Goldsmith | Specialist | 14692 179th Ave Se, Suite 400, Monroe, WA 98272-1198 | 2009-05-07 |
| 1457502551 | Providence Health & Services-wa | Clinic/Center | 14692 179th Ave Se, Suite 100, Monroe, WA 98272-1198 | 2008-10-07 |
| 1538345194 | Foot Care Associates PC | Podiatrist | 14692 179th Ave Se, Monroe, WA 98272 | 2008-01-14 |
| 1366625030 | Harmony Lynn Mckenna-clark | Specialist | 14692 179th Ave Se, Suite 400, Monroe, WA 98272-1198 | 2007-12-17 |
| 1558544098 | Nancy Lynnette Rukman | Specialist | 14692 179th Ave Se, Suite 400, Monroe, WA 98272-1198 | 2007-12-06 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710346135 | Kiran Agarwal | Internal Medicine | 17707 W Main St Fl 1, Monroe, WA 98272 | 2016-02-12 |
| 1982073136 | Rochelle Conway Toulouse | Behavioral Analyst | 642 North Street, Monroe, WA 98272 | 2015-09-17 |
| 1740658467 | Casey Jane Bahr | Social Worker | Casey Bahr, C.o. Tru- Sotap, 16550 177th Ave Se, Monroe, WA 98272 | 2015-09-11 |
| 1811395049 | Gianna M Rosewood | Massage Therapist | 101 East Main Street Set 201, Monroe, WA 98272 | 2014-12-22 |
| 1528478609 | Puget Sound Kidney Centers | Clinic/Center | 18121 149th Street Se, Monroe, WA 98272 | 2014-04-29 |
| 1215356878 | Sabiha K Barot | Emergency Medicine | Evergreenhealth Monroe, 14701 179th Ave. Se, Monroe, WA 98272 | 2014-04-10 |
| 1346677986 | Irina Emily Goldstein | Pharmacist | 179th Ave Se, Monroe, WA 98272 | 2013-09-27 |
| 1740612449 | Erik Michael Erxleben | Massage Therapist | 211 West Hill St., Monroe, WA 98272 | 2013-08-05 |
| 1780023796 | Jamie Marlo Selbe | Counselor | 16560 167th St Se, Monroe, WA 98272 | 2013-06-24 |
| 1942644620 | Robin Fenn | Counselor | 14841 179th Ave Se, St 230, Neary Naturopathic Clinic, Monroe, WA 98272 | 2013-04-24 |
| Find all providers in zip 98272 | ||||
| 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 |
|---|---|---|---|---|
| 1447886155 | Natalie Brown Shumate | Pediatrics | 1669 Pleasant Valley Rd Ne, Monroe, GA 30655-6211 | 2020-03-14 |
| 1902393648 | Morehouse Community Medical Centers, Inc | Pediatrics | 1825 N 18th St Ste A&b, Monroe, LA 71201-4420 | 2018-04-18 |
| 1700261336 | Munira A Yusuf Md | Pediatrics | 1703 Lamy Ln, Monroe, LA 71201-3737 | 2015-07-24 |
| 1366734832 | Francois Hayato Coutu | Pediatrics | 401 Monroe Tpke Ste 16, Monroe, CT 06468-2278 | 2011-05-03 |
| 1407087547 | Flor De Maria Grados Valderrama | Pediatrics | 2802 Pargoud Blvd, Monroe, LA 71201-2335 | 2009-08-06 |
| 1285809731 | Kathleen Reinhart Do PC | Pediatrics | 14930 Laplaisance Rd Ste 127, Monroe, MI 48161-3878 | 2008-04-25 |
| 1851422919 | Monroe Pediatrics | Pediatrics | 218 Martin Luther King Jr Blvd, Monroe, GA 30655-5622 | 2007-03-08 |
| 1386707362 | Munira A Yusuf | Pediatrics | 2829 W Deborah Dr, Monroe, LA 71201-1919 | 2006-12-19 |
| 1114004421 | Barbara Ann Davies | Pediatrics | 1210 Frank Dr, Monroe, MI 48162-3400 | 2006-11-01 |
| 1699850313 | Alan Werzberger | Pediatrics | 22 Van Buren Dr, Suite 102, Monroe, NY 10950-6018 | 2006-10-25 |
| Find all providers in MONROE | ||||
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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.