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ST. JOHN MEDICAL CENTER - PEACEHEALTH MEDICAL GROUP
NPI 1720056187
Clinic/Center - Multi-Specialty in Longview, WA

Active since March 10, 2006
1615 DELAWARE ST, LONGVIEW, WA 98632(360) 414-2000(360) 414-2054 Get Directions Write a Review

NPPES record last updated: July 29, 2011. Verified against the NPPES registry weekly; last sync: November 01, 2026.

About St. John Medical Center - Peacehealth Medical Group NPPES

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

ST. JOHN MEDICAL CENTER - PEACEHEALTH MEDICAL GROUP (NPI 1720056187) is a healthcare organization registered as a multi-specialty in Longview, Washington and active in the NPI registry since March 2006. The organization lists Thomas Haywood, Regional Vp/cfo, as its authorized official.

NPPES Registry Identity

NPI1720056187
Entity TypeOrganization
Primary Taxonomy261QM1300X
Legal Business NamePEACEHEALTH
Location Address1615 DELAWARE STLongview, WA 98632-2367
Mailing AddressPo Box 3002Longview, WA 98632-0302 · (360) 414-2000 · Fax (360) 414-2054
Phone(360) 414-2000
Fax(360) 414-2054
Organization SubpartNo
Authorized OfficialThomas HaywoodRegional Vp/cfo · (360) 414-5797
Enumeration DateMarch 10, 2006
Last NPPES UpdateJuly 29, 2011
✔ NPI 1720056187 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 15

★ Primary SpecialtyClinic/Center · Multi-SpecialtyAmbulatory Health Care Facilities
Taxonomy Code261QM1300X
Also ListedDietitian, RegisteredTaxonomy 133V00000X
Also ListedNeuromusculoskeletal Medicine, Sports MedicineTaxonomy 204C00000X
Also ListedAnesthesiologyTaxonomy 207L00000X
Also ListedAnesthesiology · Pain MedicineTaxonomy 207LP2900X
Also ListedFamily MedicineTaxonomy 207Q00000X
Also ListedInternal MedicineTaxonomy 207R00000X
Also ListedInternal Medicine · Cardiovascular DiseaseTaxonomy 207RC0000X
Also ListedInternal Medicine · Critical Care MedicineTaxonomy 207RC0200X
Also ListedInternal Medicine · GastroenterologyTaxonomy 207RG0100X
Also ListedInternal Medicine · Hematology & OncologyTaxonomy 207RH0003X
Also ListedInternal Medicine · NephrologyTaxonomy 207RN0300X
Also ListedInternal Medicine · RheumatologyTaxonomy 207RR0500X
Also ListedInternal Medicine · Medical OncologyTaxonomy 207RX0202X
Also ListedGeneral PracticeTaxonomy 208D00000X
1615 DELAWARE ST, Longview, WA 98632
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Other Names 1

Doing Business AsSt. John Medical Center - Peacehealth Medical Group

Other Identifiers 1

Medicare PING000747600WA

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter Health, Moda Health Plan, Inc., Premera Blue Cross Blue Shield of Alaska.Insurance ›

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

St. John Medical Center - Peacehealth Medical Group is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

312

Medicare enrollment records show 312 clinicians reassign Medicare billing to St. John Medical Center - Peacehealth Medical Group, which bills Medicare for the services they deliver. Of these, 54 practice at this address and 135 within 10 miles. Listed here are the 20 practicing nearest to this location.

Clinicians by Medicare Specialty 44

Nurse Practitioner35
General Surgery30
Family Practice27
Psychiatry27
Internal Medicine22
Certified Registered Nurse Anesthetist (CRNA)21
Neurology10
Pathology10
36 other specialties130

Nearest to this location (20)

See all 312
James Suero, MD
Interventional Cardiology
NPI 1316909419
1615 DELEWARE SPECIALTIES CLINIC
Longview, WA 98632
(360) 414-2000
✔ PECOS✔ Accepts MedicareSame address
Nichole Adams, ARNP
Nurse Practitioner
NPI 1639908486
1615 DELAWARE ST
Longview, WA 98632
(360) 414-7800
✔ PECOS✔ Accepts MedicareSame address
Basim Ali, M.B.B.S
Gastroenterology
NPI 1467081521
1615 DELAWARE ST
Longview, WA 98632
(360) 414-2730
✔ PECOS✔ Accepts MedicareSame address
Lance Amols, M.D.
Psychiatry
NPI 1780978304
1615 DELAWARE ST
Longview, WA 98632
(360) 636-4836
✔ PECOS✔ Accepts MedicareSame address
Kyle Backer, M.D.
Pathology
NPI 1487066841
1615 DELAWARE ST
Longview, WA 98632
(360) 636-8760
✔ PECOS✔ Accepts MedicareSame address
Melanie Bobbs, MD
General Surgery
NPI 1477916294
1615 DELAWARE ST
Longview, WA 98632
(360) 501-3500
✔ PECOS✔ Accepts MedicareSame address
Matthew Bolsoy, CRNA
Certified Registered Nurse Anesthetist (CRNA)
NPI 1417154428
1615 DELAWARE ST
Longview, WA 98632
(360) 414-2000
✔ Accepts MedicareSame address
Christine Crank, MD
Pediatric Medicine
NPI 1386803161
1615 DELAWARE ST
Longview, WA 98632
(360) 414-2385
✔ PECOSSame address
Rachel Deak, DO
Obstetrics/Gynecology
NPI 1184088726
1615 DELAWARE ST
Longview, WA 98632
(360) 414-2385
✔ PECOS✔ Accepts MedicareSame address
Anahita Deylamsalehi, MD
Internal Medicine
NPI 1376246868
1615 DELAWARE ST
Longview, WA 98632
(360) 501-3601
✔ PECOSSame address
Peter Goff, MD
Radiation Oncology
NPI 1053842054
1615 DELAWARE ST
Longview, WA 98632
(360) 414-7878
✔ PECOS✔ Accepts MedicareSame address
Shannon Hertzog, BS, MS
Registered Dietitian or Nutrition Professional
NPI 1124602560
1615 DELAWARE ST
Longview, WA 98632
(360) 501-3601
Same address
Daniyal Nadeem
Rheumatology
NPI 1942973433
1615 DELAWARE ST
Longview, WA 98632
(360) 414-2700
✔ PECOS✔ Accepts MedicareSame address
Muhammad Riaz, M.D
Family Practice
NPI 1053610493
1615 DELAWARE ST
Longview, WA 98632
(360) 414-7800
✔ PECOS✔ Accepts MedicareSame address
Dikshya Sharma, MD
Pulmonary Disease
NPI 1639581226
1615 DELAWARE ST
Longview, WA 98632
(360) 414-2730
✔ PECOS✔ Accepts MedicareSame address
Baljinder Singh, MD
Neurology
NPI 1114589025
1615 DELAWARE ST
Longview, WA 98632
(360) 414-2730
✔ PECOS✔ Accepts MedicareSame address
Julien Succar, M.D.
Preventive Medicine
NPI 1700220811
1615 DELAWARE ST
Longview, WA 98632
(360) 501-3601
✔ PECOS✔ Accepts MedicareSame address
Baljinder Brar, M.D.
Pain Management
NPI 1255572103
1615 DELAWARE ST
Longview, WA 98632
(360) 414-2700
✔ PECOS✔ Accepts MedicareSame address
Louis Cotterell, MD
Nephrology
NPI 1811994668
1615 DELAWARE ST
Longview, WA 98632
(360) 414-2727
✔ PECOS✔ Accepts MedicareSame address
Rebecca Foreman, M.D.
Dermatology
NPI 1962639831
1615 DELAWARE ST SUITE 200
Longview, WA 98632
(360) 501-3547
✔ PECOS✔ Accepts MedicareSame address
See all 312 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 Peacehealth's NPI number?

The NPI number for Peacehealth is 1720056187. It was assigned to this organization in the NPPES registry on March 10, 2006. The provider is doing business as St. John Medical Center - Peacehealth Medical Group.

Where is Peacehealth located?

Peacehealth is located at 1615 Delaware St, Longview, WA 98632. The listed phone number is (360) 414-2000.

What is Peacehealth's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Multi-Specialty, with taxonomy code 261QM1300X.

Is Peacehealth enrolled in Medicare?

Yes. Peacehealth is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Peacehealth?

According to the CMS Revalidation Reassignment List (October 2026 release), 312 clinicians in 44 Medicare specialties reassign their Medicare billing to Peacehealth. 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 (35), General Surgery (30) and Family Practice (27). Of these, 54 practice at this address and 135 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

What insurance does Peacehealth accept?

Health plans from Ambetter Health, Moda Health Plan, Inc. and Premera Blue Cross Blue Shield of Alaska list Peacehealth 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 Peacehealth was last updated on July 29, 2011. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 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.