WESTERN WASHINGTON MEDICAL GROUP, INC (NPI# 1528370723) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1528370723 |
| Entity Type | Organization |
| Organization Name | WESTERN WASHINGTON MEDICAL GROUP, INC |
| Other Organization Name | ORTHOPEDIC, SPORTS AND HAND CENTER |
| Practice Address |
3726 Broadway Ste 201 Everett WA 98201-3788 |
| Practice Telephone | 4253179119 |
| Practice Fax Number | 4253179118 |
| Mailing Telephone | 4253179119 |
| Mailing Fax Number | 4253179118 |
| Enumeration Date | 2010-07-06 |
| Last Update Date | 2010-07-06 |
| Authorized Official Name | MR. JERRY TILLINGER (CEO) |
| Authorized Official Telephone | 4257404149 |
| Authorized Official Credential | CEO |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
Physician Assistants & Advanced Practice Nursing Providers |
| Other Name | Type Code |
|---|---|
| Orthopedic, Sports and Hand Center | Other Name - Individual/Organization |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Washington State Corporations | WESTERN WASHINGTON MEDICAL GROUP, INC., P.S. | 1728 W Marine View Dr Ste 110, Everett, WA 98201-2094 |
| Street Address |
3726 BROADWAY STE 201 |
| City | EVERETT |
| State | WA |
| Zip Code | 98201-3788 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356326870 | Donald William Henline | Orthopaedic Surgery | 3726 Broadway Ste 201, Everett, WA 98201-3788 | 2005-12-07 |
| 1427521376 | Britni Tyne Manos | Occupational Therapy Assistant | 3726 Broadway Ste 201, Everett, WA 98201-3788 | 2019-01-03 |
| 1013493998 | Michael James Oliver | Physician Assistant | 3726 Broadway Ste 201, Everett, WA 98201-3788 | 2018-07-13 |
| 1275027781 | Lindsay Portz | Physician Assistant | 3726 Broadway Ste 201, Everett, WA 98201-3788 | 2018-06-18 |
| 1780122242 | Kristen Nicole Burke | Physician Assistant | 3726 Broadway Ste 201, Everett, WA 98201-3788 | 2017-02-05 |
| 1871038109 | Derek Henderson | Physician Assistant | 3726 Broadway Ste 201, Everett, WA 98201-3788 | 2016-12-22 |
| 1699195990 | Mithun Neral | Orthopaedic Surgery | 3726 Broadway Ste 201, Everett, WA 98201-3788 | 2014-04-24 |
| 1558609578 | Julie Lorraine Patterson | Physician Assistant | 3726 Broadway Ste 201, Everett, WA 98201-3788 | 2013-01-25 |
| 1487990362 | Yury Filitovich | Physician Assistant | 3726 Broadway Ste 201, Everett, WA 98201-3788 | 2012-12-20 |
| 1336491588 | Brandon Ross Wilson | Physician Assistant | 3726 Broadway Ste 201, Everett, WA 98201-3788 | 2012-10-12 |
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| 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 |
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| Taxonomy Code | 363AS0400X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Surgical Technologist |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295822740 | Gregory Douglas Stewart Sr. | Physician Assistant | 2424 122nd St Sw, B, Everett, WA 98204-4744 | 2006-10-06 |
| 1003881020 | James Potocsnak | Physician Assistant | 2320 Rucker Ave, Everett, WA 98201 | 2006-02-22 |
| 1710979521 | Eric M Tilley | Physician Assistant | 728 134th St Sw Ste 120, Radia Inc., Ps, Everett, WA 98204-5322 | 2005-08-17 |
| 1003271339 | Christine Reichert | Physician Assistant | 1330 Rockefeller Ave Ste 400, Everett, WA 98201-1676 | 2015-12-31 |
| 1396132015 | Alvin Abueg | Physician Assistant | 3927 Rucker Ave, Everett, WA 98201-4833 | 2015-04-21 |
| 1598167074 | Jon Pennington | Physician Assistant | 3726 Broadway, Suite 201, Everett, WA 98201-3787 | 2014-09-16 |
| 1528496858 | James Albert Marsh | Physician Assistant | 3927 Rucker Ave, Everett, WA 98201-4833 | 2013-10-23 |
| 1558609578 | Julie Lorraine Patterson | Physician Assistant | 3726 Broadway Ste 201, Everett, WA 98201-3788 | 2013-01-25 |
| 1871809517 | Amanda Farrell | Physician Assistant | 103 Garland St, Everett, MA 02149 | 2010-08-19 |
| 1598083743 | Nicolae Vadan | Physician Assistant | 1330 Rockefeller Ave, Suite 400, Everett, WA 98201-1684 | 2010-05-12 |
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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.