WESTERN WASHINGTON MEDICAL GROUP, INC PS
NPI 1396413803
Psychiatry & Neurology - Psychiatry in Everett, WA
About Western Washington Medical Group, Inc Ps NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
WESTERN WASHINGTON MEDICAL GROUP, INC PS (NPI 1396413803), doing business as Wwmg Department Of Psychiatry, is a healthcare organization registered as a psychiatry in Everett, Washington and active in the NPI registry since August 2021. The organization holds a CLIA Waiver certificate valid through April 4, 2028 and lists Kimberly Holstein, Director Corporate Compliance, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Other Names 1
Group Practice 1
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Western Washington Medical Group, Inc Ps is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
90Medicare enrollment records show 90 clinicians reassign Medicare billing to Western Washington Medical Group, Inc Ps, which bills Medicare for the services they deliver. Of these, 31 practice at this address and 67 within 10 miles. Listed here are the 20 practicing nearest to this location.
Clinicians by Medicare Specialty 21
Nearest to this location (20)
See all 90Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
CLIA Laboratory Certificates CMS CLIA
Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.
Certificate of Waiver 50D2025751
Western Washington Medical Group - Clinical Research · Everett, WAFrequently 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 Western Washington Medical Group, Inc Ps's NPI number?
The NPI number for Western Washington Medical Group, Inc Ps is 1396413803. It was assigned to this organization in the NPPES registry on August 31, 2021. The provider is doing business as WWMG Department of Psychiatry.
Where is Western Washington Medical Group, Inc Ps located?
Western Washington Medical Group, Inc Ps is located at 12728 19th Ave SE Ste 300, Everett, WA 98208. The listed phone number is (425) 252-1116.
What is Western Washington Medical Group, Inc Ps's specialty?
The primary specialty registered for this NPI is Psychiatry & Neurology, specializing in Psychiatry, with taxonomy code 2084P0800X.
Is Western Washington Medical Group, Inc Ps enrolled in Medicare?
Yes. Western Washington Medical Group, Inc Ps is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Western Washington Medical Group, Inc Ps?
According to the CMS Revalidation Reassignment List (October 2026 release), 90 clinicians in 21 Medicare specialties reassign their Medicare billing to Western Washington Medical Group, Inc Ps. 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 Nurse Practitioner (23), Family Practice (11) and Pulmonary Disease (9). Of these, 31 practice at this address and 67 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Western Washington Medical Group, Inc Ps hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 50D2025751) is associated with this NPI, valid through April 4, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
When was this NPI record last updated?
The NPPES record for Western Washington Medical Group, Inc Ps was last updated on August 31, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years 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.
# Western Washington Medical Group, Inc Ps · NPI 1396413803
Psychiatry organization in Everett, Washington. Organization record, active in the CMS NPPES registry since August 31, 2021.
## Identity
- **NPI:** 1396413803 (Entity type: Organization)
- **Enumerated:** August 31, 2021
- **Primary specialty:** Psychiatry & Neurology - Psychiatry · taxonomy 2084P0800X
- **Also known as:** WWMG Department of Psychiatry (Doing Business As)
- **Organization subpart:** No
- **Authorized official:** Kimberly Holstein, DIRECTOR CORPORATE COMPLIANCE
## Practice location
- **Address:** 12728 19TH AVE SE STE 300, Everett, WA 98208-6526
- **Phone:** (425) 252-1116
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 90 clinicians in 21 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Nurse Practitioner (23), Family Practice (11), Pulmonary Disease (9); 31 practice at this address and 67 within 10 miles; [full list](https://npiprofile.com/npi/1396413803/clinicians) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** August 31, 2021
- **CLIA laboratory certificates:** 1 on file
---
Source: [NPI Profile](https://npiprofile.com/npi/1396413803) · Data from the CMS NPPES public registry.