PROVIDENCE HEALTH & SERVICES WASHINGTON
NPI 1215431697
Clinic/Center in Lacey, WA

Q: What is Providence Health & Services Washington's specialty?

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

Active since March 21, 2018

4800 COLLEGE ST SE, LACEY, WA 98503(360) 493-7567(360) 412-6468 Get Directions Write a Review

NPPES record last updated: May 12, 2025. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: May 12, 2025, Mar 21, 2025, Mar 21, 2018 (3 updates tracked since 2018).

On this page

About Providence Health & Services Washington NPPES

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

PROVIDENCE HEALTH & SERVICES WASHINGTON (NPI 1215431697), doing business as Providence Medical Group Sw Wa - Mdpp, is a healthcare organization registered as a clinic/center in Lacey, Washington and active in the NPI registry since March 2018. The organization lists Donald Wayne Anderson, Assistant Secretary Of Enrollments, as its authorized official.

NPPES Registry Identity

NPI1215431697

Entity TypeOrganization

Primary Taxonomy261Q00000X

Legal Business NamePROVIDENCE HEALTH & SERVICES WASHINGTON

Location Address4800 COLLEGE ST SELacey, WA 98503-4389

Mailing AddressPo Box 31001-4114Pasadena, CA 91110-4114 · (360) 493-7567 · Fax (360) 412-6468

Phone(360) 493-7567

Fax(360) 412-6468

Organization SubpartNo

Authorized OfficialDonald Wayne AndersonAssistant Secretary Of Enrollments · (425) 358-9786

Enumeration DateMarch 21, 2018

Last NPPES UpdateMay 12, 20253 updates tracked since enumeration

NPPES CertifiedMay 12, 2025

✔ NPI 1215431697 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/CenterAmbulatory Health Care Facilities

Taxonomy Code261Q00000X

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).

4800 COLLEGE ST SE, Lacey, WA 98503

Open in Google Maps ↗

Other Names 1

Doing Business AsProvidence Medical Group Sw Wa - Mdpp

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Providence Health Plan.Insurance ›

Areas of Expertise CMS Part B claims

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

The mdpp beneficiary achieved at least 5% weight loss (wl) from his/her baseline weight in months 1-12 of the mdpp services period under the mdpp expanded model (em). this is a one-time payment available when a beneficiary first achieves at least 5% weight G9880

The MDPP Expanded Model is a program that rewards weight loss. If a participant loses at least 5% of their baseline weight within the first year of the program, they receive a one-time payment. This incentive is only available the first time a participant achieves this weight loss goal.

11 services11 patients

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

JUMAN PARK DPT

Physical Therapist

4800 COLLEGE ST SE
LACEY, WA 98503

Thurston County (360) 486-2900

DR. ABRAHAM WUSEOK JEON DO

Family Medicine

4800 COLLEGE ST SE, PMG SW WA LACEY FAM MED
LACEY, WA 98503

Thurston County (360) 486-2900

GRIGORIY A ROZENFELD DO

Emergency Medicine

4800 COLLEGE ST SE
LACEY, WA 98503

Thurston County (360) 486-2900

KAREN LEE NEWMAN

Counselor

4800 COLLEGE ST SE
LACEY, WA 98503

Thurston County (360) 493-5722

IAN SERRATO

Nurse Practitioner (Family)

4800 COLLEGE ST SE
LACEY, WA 98503

Thurston County (360) 493-4500

MICHAELA JANE DE GROOT PT, DPT

Physical Therapist

4800 COLLEGE ST SE
LACEY, WA 98503

Thurston County (360) 486-2900

CARA ELIZABETH BARDWELL PA-C

Physician Assistant

4800 COLLEGE ST SE
LACEY, WA 98503

Thurston County (360) 486-2900

STEPHANIE MARY DEMPSEY RN

Registered Nurse

4800 COLLEGE ST SE
LACEY, WA 98503

Thurston County (360) 486-2900

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 1215431697. It was assigned to this organization in the NPPES registry on March 21, 2018. The provider is doing business as Providence Medical Group SW WA - MDPP.

Where is Providence Health & Services Washington located?

Providence Health & Services Washington is located at 4800 College St SE, Lacey, WA 98503. The listed phone number is (360) 493-7567.

What is Providence Health & Services Washington's specialty?

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

What insurance does Providence Health & Services Washington accept?

Health plans from Providence Health Plan list Providence Health & Services Washington as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Providence Health & Services Washington was last updated on May 12, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 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.