EASTSIDE INTERNAL MEDICINE PLLC (NPI# 1023165594) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1023165594 |
| Entity Type | Organization |
| Organization Name | EASTSIDE INTERNAL MEDICINE PLLC |
| Practice Address |
12333 Ne 120th Ln. Ste 310 Kirkland WA 98034 |
| Practice Telephone | 4258996700 |
| Practice Fax Number | 4258996701 |
| Enumeration Date | 2007-01-05 |
| Last Update Date | 2007-12-18 |
| Authorized Official Name | DR. DOUGLAS A PORTELANCE (MD PRESIDENT) |
| Authorized Official Telephone | 4258996700 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM2500X |
Clinic/Center Specialization: Medical Specialty |
WA | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WA | LABOR & INDUSTRIES | 145684 | 01 |
| Street Address |
12333 NE 120TH LN. STE 310 |
| City | KIRKLAND |
| State | WA |
| Zip Code | 98034 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578116596 | Rachel Bowers | Behavior Technician | 1335 Northeast 122nd Way, Suite 105, Kirkland, WA 98034 | 2019-07-18 |
| 1740841048 | Kristina Louise Inghram | Behavior Technician | 11415 Ne 128th St., Suite 40, Kirkland, WA 98034 | 2019-06-26 |
| 1053978064 | Matthew A. Bagnulo, Dds, Ps | Dentist | 11830 Ne 128th St., #202, Kirkland, WA 98034 | 2019-05-24 |
| 1629568928 | Stephanie Michalko | Optometrist | 11800 Ne 128th St Ste 110, Kirkland, WA 98034 | 2018-05-14 |
| 1952800013 | Heath Family Counseling LLC | Marriage & Family Therapist | 12025 115th Ave. Ne, Building D, Ste 200, Kirkland, WA 98034 | 2018-02-05 |
| 1891202834 | Barbara Josephine Gorham | Counselor | 2025 115th Ave Ne, Bldg D, #200, Kirkland, WA 98034 | 2017-12-29 |
| 1548782915 | Eleanor Hollis Wall | Counselor | 14340 102nd Ave Ne, Kirkland, WA 98034 | 2017-07-07 |
| 1457885212 | Peter Schoonmaker | Hospitalist | 12040 Ne 128th Street, Ms105, Kirkland, WA 98034 | 2017-04-18 |
| 1780124370 | Rebecca Managan | Advanced Practice Midwife | 12303 Ne 130th Ln Ste Coral225, Kirkland, WA 98034 | 2017-03-01 |
| 1669821104 | Winter Gonzalez | Counselor | 11720 97th Ln Ne Apt A411, Kirkland, WA 98034 | 2016-06-06 |
| Find all providers in zip 98034 | ||||
| Taxonomy Code | 261QM2500X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Medical Specialty |
| An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer). |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689919292 | Poma Fertility, LLC | Clinic/Center | 12039 Ne 128th St Ste 110, Kirkland, WA 98034-3030 | 2012-12-07 |
| 1447314661 | Kirkland Dermatology Associates, Pllc | Clinic/Center | 11800 Ne 128th St Ste 450, Kirkland, WA 98034 | 2006-12-21 |
| 1558918219 | Kirkland Rheumatology LLC | Clinic/Center | 11417 124th Ave Ne Ste 103, Kirkland, WA 98033-4677 | 2019-08-19 |
| 1437604428 | Christine M James Nd Pllc | Clinic/Center | 13531 Juanita Woodinville Way Ne, Kirkland, WA 98034-5225 | 2016-08-18 |
| 1669717278 | Poma Fertility Medical Associates, Pllc | Clinic/Center | 12039 Ne 128th St Ste 110, Kirkland, WA 98034-3030 | 2012-12-07 |
| 1992062368 | Comprehensive Natural Medicine | Clinic/Center | 11821 Ne 128th Street, Suite H, Kirkland, WA 98034 | 2012-04-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619592946 | Inner Vitality Pllc | Clinic/Center | 11711 Ne 12th St Ste 1a, Bellevue, WA 98005-2461 | 2020-06-12 |
| 1578057337 | Regenerative Medicine Northwest | Clinic/Center | 1260 116th Ave Ne Ste 200, Bellevue, WA 98004-3800 | 2018-06-15 |
| 1154837854 | Pacific Northwest Lactation, LLC | Clinic/Center | 708 S Cushman Ave, Tacoma, WA 98405-3625 | 2017-12-18 |
| 1275052458 | Peninsula Spine Institute, Ps | Clinic/Center | 804 Callahan Dr Ste A, Bremerton, WA 98310-3307 | 2017-09-19 |
| 1477097251 | Cynthia D Gray Md PC | Clinic/Center | 2101 Ne 139th St Ste 285, Vancouver, WA 98686-2326 | 2016-12-13 |
| 1811377484 | Knead To Heal, LLC | Clinic/Center | 2312 Rucker Ave, Everett, WA 98201-2723 | 2015-06-09 |
| 1699185348 | Duane Fredrick Hopp | Clinic/Center | 22612 126th Ave E, Graham, WA 98338-6725 | 2014-05-03 |
| 1275888232 | Massage Mundo | Clinic/Center | 423 Eastlake Ave E, Seattle, WA 98109-5408 | 2012-07-16 |
| 1144536079 | 3-d Diagnostics, LLC | Clinic/Center | 2616 Yelm Hwy Se Ste A, Olympia, WA 98501-0800 | 2010-08-30 |
| 1588982060 | Assured Imaging Womens Wellness of Washington, LLC | Clinic/Center | 565 Andover Park W Ste 110, Tukwila, WA 98188-3357 | 2010-05-10 |
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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.