PRAVEEN KUMAR MAMBALAM M.D.
NPI 1790942886
Anesthesiology - Pain Medicine in Edmonds, WA

Q: What is Praveen Mambalam's NPI number?

The NPI number for Praveen Mambalam is 1790942886. It was assigned to this individual provider in the NPPES registry on May 17, 2008.

Q: What is Praveen Mambalam's specialty?

The primary specialty registered for this NPI is Anesthesiology, specializing in Pain Medicine, with taxonomy code 207LP2900X.

Q: When was this NPI record last updated?

The NPPES record for Praveen Mambalam was last updated on May 23, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 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.

Active since May 17, 2008PECOS EnrolledAccepts Medicare Assignment

75/100

CMS Quality Rating

21616 76TH AVE W, STE 102, EDMONDS, WA 98026(425) 774-1538(425) 744-1527 Get Directions Write a Review

NPPES record last updated: May 23, 2023. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: May 23, 2023, Feb 9, 2023, Sep 1, 2022 (3 updates tracked since 2022).

On this page

About Praveen Kumar Mambalam M.d. NPPES

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

PRAVEEN KUMAR MAMBALAM M.D. (NPI 1790942886) is an individual pain medicine provider in Edmonds, Washington, licensed in Washington (MD 00049423) and active in the NPI registry since May 2008. He is enrolled in Medicare PECOS, is affiliated with Providence Centralia Hospital, and maintains a secondary practice location in Olympia.

NPPES Registry Identity

NPI1790942886

Entity TypeIndividualMale

Primary Taxonomy207LP2900X

Provider Legal NamePRAVEEN KUMAR MAMBALAMCredential: M.D.

Location Address21616 76TH AVE W, STE 102Edmonds, WA 98026-7512

Mailing AddressPo Box 827Bellevue, WA 98009-0827 · (425) 774-1538 · Fax (425) 744-1527

Phone(425) 774-1538

Fax(425) 744-1527

Sole ProprietorNo

Medical School CMSOtherGraduated 2004

Enumeration DateMay 17, 2008

Last NPPES UpdateMay 23, 20233 updates tracked since enumeration

NPPES CertifiedMay 23, 2023

✔ NPI 1790942886 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyAnesthesiology · Pain MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207LP2900X

License✔ Licensed in WA · MD 00049423

Definition

An anesthesiologist who provides a high level of care, either as a primary physician or consultant, for patients experiencing problems with acute, chronic and/or cancer pain in both hospital and ambulatory settings. Patient care needs are also coordinated with other specialists.

21616 76TH AVE W, Edmonds, WA 98026

Open in Google Maps ↗

Secondary Practice Location 1

Location 1155 Lilly Rd NE Ste BOlympia, WA 98506-5028 · Phone (206) 538-6300 · Fax (206) 538-6301

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include BridgeSpan Health Company, Moda Health Plan, Inc., Regence BlueCross BlueShield of Oregon.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Praveen Kumar Mambalam M.d. is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID5597822387

PECOS Enrollment IDI20090323000363, I20240124000595, I20240223002411, I20240507000764

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignments

Medicare enrollment records show Praveen Mambalam reassigns Medicare billing to 7 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Washington Center For Pain Management LLC

9.1 mi

Interventional Pain Medicine

607 SE EVERETT MALL WAY STE 2
Everett, WA 98208

Reassigned Medicare billing, Washington enrollment
8 clinicians in this Medicare group

NPI 1114528056 (425) 774-1538

Pain Care Physicians PLLC

13 mi

Interventional Pain Medicine

3305 NASSAU ST STE A
Everett, WA 98201

Reassigned Medicare billing, Washington enrollment
Also billed through NPI 1144779232 (Washington)
19 clinicians in this Medicare group

NPI 1477116697 (206) 538-6300

Washington Pain And Spine Specialists LLC

57 mi

Pain

3525 ENSIGN RD NE STE J
Olympia, WA 98506

Reassigned Medicare billing, Washington enrollment
8 clinicians in this Medicare group

NPI 1992486906 (240) 463-4101

Progressive Rehabilitation Associates LLC

161 mi

Clinic/Center

4640 S MACADAM AVE STE 90
Portland, OR 97239

Reassigned Medicare billing, Oregon enrollment
23 clinicians in this Medicare group

NPI 1790760908 (503) 292-0765

Pain And Spine Specialists Of Maryland, LLC

2,307 mi

Specialist

2702 BACK ARCE CIRCLE, 290B
Mount Airy, MD 21771

Reassigned Medicare billing, District of Columbia, Florida and Maryland enrollments
28 clinicians in this Medicare group

NPI 1174884258 (301) 703-8767

Simcare ASC LLC

2,307 mi

Ambulatory Surgical

2702 BACK ACRE CIR, SUITE 290A
Mount Airy, MD 21771

Reassigned Medicare billing, Maryland enrollment
3 clinicians in this Medicare group

NPI 1538427943 (732) 309-5384

Elkridge ASC LLC

2,331 mi

Ambulatory Surgical

6816 DEERPATH RD
Elkridge, MD 21075

Reassigned Medicare billing, Maryland enrollment
6 clinicians in this Medicare group

NPI 1487169769 (410) 796-1577

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

Areas of Expertise CMS Part B claims 18

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.

Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214

This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.

494 services138 patients

New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more 99204

This is a first-time office or outpatient visit lasting between 45-59 minutes. The healthcare provider evaluates your health, discusses your medical history, and may suggest further tests or treatments. It's an opportunity to ask questions and understand your health better.

75 services75 patients

Use of a drug to induce depression of consciousness by physician performing a procedure (5 years or older), initial 15 minutes 99152

This procedure involves a doctor administering a medication to reduce your consciousness during a procedure. This helps in managing discomfort and anxiety. The initial application lasts for 15 minutes and is for individuals aged 5 years or older.

71 services48 patients

Insertion of spinal neurostimulator electrode array through skin 63650

This procedure involves placing a small device, called a neurostimulator electrode array, under your skin near your spine. It delivers mild electrical signals to your spinal cord, helping to manage chronic pain.

46 services16 patients

Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213

This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.

44 services31 patients

Destruction of lower or sacral spinal facet joint nerves using imaging guidance, single facet joint 64635

This procedure involves using imaging guidance to accurately target and destroy nerves in the lower or sacral spinal facet joint. It's done to relieve chronic back pain. The process is safe and usually effective.

30 services21 patients

Electronic analysis of implanted neurostimulator generator with complex spinal cord or peripheral nerve stimulator programming 95972

This procedure involves electronically analyzing an implanted neurostimulator. This device sends electrical pulses to your spinal cord or peripheral nerves to manage pain. The programming is complex, requiring expert analysis to ensure proper functioning.

27 services20 patients

Destruction of lower or sacral spinal facet joint nerves using imaging guidance, each additional facet joint 64636

This procedure involves using imaging technology to locate and treat nerves in your lower spine or sacral area that may be causing pain. Each additional facet joint refers to treating more than one spinal nerve. It's a non-invasive way to manage chronic back pain.

26 services19 patients

Injection of lower or sacral spine facet joint using imaging guidance, single level 64493

This procedure involves injecting medication into the facet joint in your lower back or sacral spine. It's done under imaging guidance to ensure accuracy. The aim is to alleviate pain and inflammation. It's a safe, often effective method for managing spinal discomfort.

25 services17 patients

Injection of lower or sacral spine facet joint using imaging guidance, second level 64494

This procedure involves injecting medication into the facet joints of your lower or sacral spine to manage pain. Imaging guidance ensures accurate placement. It's the second level, meaning it's done on two different joint levels.

25 services17 patients

Removal of bone from lower spine for decompression of nerve tissue using imaging guidance, accessed through the skin 0275T

This procedure involves removing a small portion of bone from your lower spine. The goal is to relieve pressure on your nerve tissue, improving comfort and mobility. It is done through the skin using imaging technology to ensure precision and safety.

22 services22 patients

Ultrasonic guidance for needle placement 76942

Ultrasonic guidance for needle placement is a technique where sound waves create images that help accurately position the needle during procedures. This method ensures precision, minimizes discomfort, and increases safety.

18 services14 patients

Administration of psychological or neuropsychological test by technician, first 30 minutes 96138

This procedure involves a trained technician administering a psychological or neuropsychological test. It's a process that assesses your mental function and behavior. The initial session will last 30 minutes. The aim is to understand your cognitive abilities better.

17 services16 patients

Injection of anesthetic or steroid into joint between lower spine and hip bone using imaging guidance 27096

This procedure involves injecting medicine into the joint where your lower spine meets your hip bone. Using special imaging technology, the doctor ensures the medicine is delivered accurately. This can help reduce pain and inflammation in that area.

15 services13 patients

Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more 99215

This service involves a follow-up appointment for existing patients, lasting between 40 to 54 minutes. During this time, your healthcare provider will assess your current health status, discuss any changes or concerns, review your treatment plan, and answer any questions you may have.

15 services15 patients

Injection of substance into lower spine canal using imaging guidance 62323

This procedure involves injecting a substance into your lower spine canal, guided by real-time images. It's done to diagnose or treat various conditions. You may feel slight discomfort, but it's generally safe and can provide valuable information for your treatment plan.

14 services12 patients

Injection of anesthetic and/or steroid drug into sacral spine nerve root using imaging guidance, single level 64483

This procedure involves injecting a mix of numbing and anti-inflammatory medication into a specific nerve root in the lower back. It helps manage pain and reduce inflammation. The process is guided by imaging technology for precision.

13 services11 patients

Electronic analysis of implanted neurostimulator generator with simple spinal cord or peripheral nerve stimulator programming 95971

This procedure involves the use of electronic devices to analyze and adjust an implanted neurostimulator. The neurostimulator helps manage pain by sending mild electrical signals to your spinal cord or peripheral nerves. This analysis ensures it's functioning properly.

12 services11 patients

Hospital Affiliations CMS Care Compare 3

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Providence Centralia Hospital

Acute Care Hospitals · Centralia, WA

3/5 CMS rating

OwnershipVoluntary non-profit - Other

CMS Certification Number500019

Location914 S Scheuber RoadCentralia, WA 98531 · Lewis County

Emergency services Birthing friendly

Providence St Peter Hospital

Acute Care Hospitals · Olympia, WA

3/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number500024

Location413 Lilly Road NEOlympia, WA 98506 · Thurston County

Emergency services Birthing friendly

Grays Harbor Community Hospital

Acute Care Hospitals · Aberdeen, WA

2/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number500031

Location915 Anderson DriveAberdeen, WA 98520 · Grays Harbor County

Emergency services Birthing friendly

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

75/100

MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program

Scored as part of a group practice

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.

DR. LORI OLSON CALDWELL AU.D.

Audiologist-Hearing Aid Fitter

21616 76TH AVE W, SUITE 112
EDMONDS, WA 98026

Snohomish County (425) 775-6651

DR. HENRY S CHANG MD

Otolaryngology

21616 76TH AVE W, SUITE 112
EDMONDS, WA 98026

Snohomish County (425) 775-6651

DR. ARPENIK AVAKIAN M.D., PH.D.

Ophthalmology

21616 76TH AVE W, STE 104
EDMONDS, WA 98026

Snohomish County (425) 275-9975

DR. SHAWN E ROGERS M.D.

Otolaryngology

21616 76TH AVE W, SUITE 112
EDMONDS, WA 98026

Snohomish County (425) 775-6651

KIMBERLY J. DICKEY DO

Obstetrics & Gynecology

21616 76TH AVE W, #205
EDMONDS, WA 98026

Snohomish County (425) 640-4810

ROSE ANN RHODES SOCIAL WORKER

Social Worker (Clinical)

21616 76TH AVE W, SUITE 102
EDMONDS, WA 98026

Snohomish County (425) 774-1538

DR. JOHN T PARKER MD

Otolaryngology

21616 76TH AVE W, SUITE 112
EDMONDS, WA 98026

Snohomish County (425) 775-6651

MARY K NEERING MD

Obstetrics & Gynecology

21616 76TH AVE W, #205
EDMONDS, WA 98026

Snohomish County (425) 640-4810

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 Praveen Mambalam's NPI number?

The NPI number for Praveen Mambalam is 1790942886. It was assigned to this individual provider in the NPPES registry on May 17, 2008.

Where is Praveen Mambalam located?

Praveen Mambalam practices at 21616 76th Ave W Ste 102, Edmonds, WA 98026. The listed phone number is (425) 774-1538.

What is Praveen Mambalam's specialty?

The primary specialty registered for this NPI is Anesthesiology, specializing in Pain Medicine, with taxonomy code 207LP2900X.

Is Praveen Mambalam enrolled in Medicare?

Yes. Praveen Mambalam is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organizations bill Medicare for Praveen Mambalam's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Praveen Mambalam reassigns Medicare benefits to 7 organizations: Washington Center For Pain Management LLC (Everett, WA), Pain Care Physicians PLLC (Everett, WA), Washington Pain And Spine Specialists LLC (Olympia, WA), Progressive Rehabilitation Associates LLC (Portland, OR), Pain And Spine Specialists Of Maryland, LLC (Mount Airy, MD) and 2 more organizations, listed in the Medicare section above. Each 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 Praveen Mambalam's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Praveen Mambalam accept?

Health plans from BridgeSpan Health Company, Moda Health Plan, Inc. and Regence BlueCross BlueShield of Oregon list Praveen Mambalam 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.

Is Praveen Mambalam affiliated with any hospitals?

According to CMS data, Praveen Mambalam is affiliated with Providence Centralia Hospital, Providence St Peter Hospital and Grays Harbor Community Hospital.

When was this NPI record last updated?

The NPPES record for Praveen Mambalam was last updated on May 23, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 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.