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PROVIDENCE HEALTH & SERVICES WASHINGTON
NPI 1063611408
Clinic/Center in Lacey, WA

Active since July 16, 2007
420 GOLF CLUB RD SE, SUITE 203, LACEY, WA 98503(360) 493-7469(360) 459-2023 Get Directions Write a Review

NPPES record last updated: July 25, 2025. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Mar 7, 2025, Oct 31, 2017 (2 updates tracked since 2017).

About Providence Health & Services Washington NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PROVIDENCE HEALTH & SERVICES WASHINGTON (NPI 1063611408) is a healthcare organization registered as a clinic/center in Lacey, Washington and active in the NPI registry since July 2007. The organization lists Donald Wayne Anderson, Assistant Secretary For Enrollment, as its authorized official.

NPPES Registry Identity

NPI1063611408
Entity TypeOrganization
Primary Taxonomy261Q00000X
Legal Business NamePROVIDENCE HEALTH & SERVICES WASHINGTON
Location Address420 GOLF CLUB RD SE, SUITE 203Lacey, WA 98503-1048
Mailing AddressPo Box 31001-4110Pasadena, CA 91110-4110 · (425) 525-6717 · Fax (425) 525-6700
Phone(360) 493-7469
Fax(360) 459-2023
Organization SubpartNo
Authorized OfficialDonald Wayne AndersonAssistant Secretary For Enrollment · (425) 358-9786
Enumeration DateJuly 16, 2007
Last NPPES UpdateJuly 25, 20252 updates tracked since enumeration
NPPES CertifiedJuly 25, 2025
✔ NPI 1063611408 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/CenterAmbulatory Health Care Facilities
Taxonomy Code261Q00000X
License✔ Licensed in WA · H-159
Definition
A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).
420 GOLF CLUB RD SE, Lacey, WA 98503
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Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Providence Health & Services Washington is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

184

Medicare enrollment records show 184 clinicians reassign Medicare billing to Providence Health & Services Washington, which bills Medicare for the services they deliver. Of these, 95 practice within 10 miles. Listed here are the 20 practicing nearest to this location.

Clinicians by Medicare Specialty 29

Internal Medicine30
Nurse Practitioner21
Family Practice12
Obstetrics/Gynecology11
Pulmonary Disease10
Cardiovascular Disease (Cardiology)9
Hospice/Palliative Care9
Urology9
21 other specialties73

Nearest to this location (20)

See all 184
Anish Konde, M.D.
Hematology/Oncology
NPI 1417343971
4525 3RD AVE SE STE 200
Lacey, WA 98503
(360) 754-3934
✔ PECOS✔ Accepts Medicare0.1 mi
Mijung Lee, MD
Medical Oncology
NPI 1093970048
4525 3RD AVE SE STE 200
Lacey, WA 98503
(360) 754-3934
✔ PECOS✔ Accepts Medicare0.1 mi
John O'boyle, M.D.
Gynecological Oncology
NPI 1306808381
4525 3RD AVE SE STE 200
Lacey, WA 98503
(360) 754-3934
✔ PECOS✔ Accepts Medicare0.1 mi
Robert Ore, M.D.
Gynecological Oncology
NPI 1326213794
4525 3RD AVE SE STE 200
Lacey, WA 98503
(360) 754-3934
✔ PECOS✔ Accepts Medicare0.1 mi
Paul Robertson, MD
Hematology/Oncology
NPI 1639175938
4525 3RD AVE SE STE 200
Lacey, WA 98503
(360) 754-3934
✔ PECOS0.1 mi
Brady Miller, MD
Medical Oncology
NPI 1902915945
4525 3RD AVE SE STE 200
Lacey, WA 98503
(360) 754-3934
✔ PECOS✔ Accepts Medicare0.1 mi
Rebecca Broderick, ACNPC-AG, BSN, RN
Nurse Practitioner
NPI 1629755657
677 WOODLAND SQUARE LOOP SE STE D7
Lacey, WA 98503
(703) 447-6155
✔ PECOS✔ Accepts Medicare0.2 mi
Louise May, M.D.
Vascular Surgery
NPI 1982961173
128 LILLY RD NE STE 205
Olympia, WA 98506
(360) 493-7444
✔ PECOS✔ Accepts Medicare0.8 mi
Sara Wasilenko, D.O.
Vascular Surgery
NPI 1528387941
128 LILLY RD NE STE 205
Olympia, WA 98506
(360) 493-7444
✔ PECOS✔ Accepts Medicare0.8 mi
Thomas Curry, MD
Vascular Surgery
NPI 1811974652
128 LILLY RD NE STE 205
Olympia, WA 98506
(360) 493-7444
✔ PECOS✔ Accepts Medicare0.8 mi
Haroon Yousaf, MD
Interventional Cardiology
NPI 1871731364
3620 ENSIGN RD NE STE B
Olympia, WA 98506
(360) 884-0052
✔ PECOS✔ Accepts Medicare0.9 mi
Patrick Murray, M.D.
Urology
NPI 1548606346
149 LILLY RD NE
Olympia, WA 98506
(360) 486-6772
✔ PECOS✔ Accepts Medicare0.9 mi
Dustin Engelken, MD
Pulmonary Disease
NPI 1174683007
500 LILLY RD NE STE 201
Olympia, WA 98506
(360) 413-8272
✔ PECOS✔ Accepts Medicare1.0 mi
William Brennan, MD
Cardiovascular Disease (Cardiology)
NPI 1487655858
500 LILLY RD NE STE 100
Olympia, WA 98506
(360) 413-8525
✔ PECOS1.0 mi
Jeffrey Christenson, MD
Pulmonary Disease
NPI 1932162872
500 LILLY RD NE
Olympia, WA 98506
(360) 413-8272
✔ PECOS1.0 mi
Gopal Ghimire, MD, PHD, MRCP
Interventional Cardiology
NPI 1811225923
500 LILLY RD NE STE 100 PROVIDENCE CARDIOLOGY ASSOCIATES
Olympia, WA 98506
(360) 413-8525
✔ PECOS✔ Accepts Medicare1.0 mi
Kamal Joshi, M.D.
Cardiovascular Disease (Cardiology)
NPI 1508020801
500 LILLY RD NE STE 100
Olympia, WA 98506
(360) 413-8525
✔ PECOS✔ Accepts Medicare1.0 mi
David Nesheim, MD
Critical Care (Intensivists)
NPI 1205253481
500 LILLY RD NE STE 204
Olympia, WA 98506
(360) 413-8272
✔ PECOS✔ Accepts Medicare1.0 mi
Robert Wark, MD
Cardiac Electrophysiology
NPI 1730181769
500 LILLY RD NE STE 100
Olympia, WA 98506
(360) 413-8525
✔ PECOS✔ Accepts Medicare1.0 mi
Mordechai Groner, M.D.
Infectious Disease
NPI 1427347764
3525 ENSIGN RD NE STE F
Olympia, WA 98506
(360) 493-4001
✔ PECOS✔ Accepts Medicare1.0 mi
See all 184 clinicians

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Providence Health & Services Washington's NPI number?

The NPI number for Providence Health & Services Washington is 1063611408. It was assigned to this organization in the NPPES registry on July 16, 2007.

Where is Providence Health & Services Washington located?

Providence Health & Services Washington is located at 420 Golf Club Rd SE Suite 203, Lacey, WA 98503. The listed phone number is (360) 493-7469.

What is Providence Health & Services Washington's specialty?

The primary specialty registered for this NPI is Clinic/Center with taxonomy code 261Q00000X.

Is Providence Health & Services Washington enrolled in Medicare?

Yes. Providence Health & Services Washington is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Providence Health & Services Washington?

According to the CMS Revalidation Reassignment List (October 2026 release), 184 clinicians in 29 Medicare specialties reassign their Medicare billing to Providence Health & Services Washington. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. The largest specialties are Internal Medicine (30), Nurse Practitioner (21) and Family Practice (12). Of these, 95 practice within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Providence Health & Services Washington was last updated on July 25, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.