PROVIDENCE HEALTH & SERVICES - WASHINGTON
NPI 1912158023
Plastic Surgery in Everett, WA

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

The primary specialty registered for this NPI is Plastic Surgery with taxonomy code 208200000X.

Active since October 07, 2008

12800 BOTHELL EVERETT HWY, SUITE 260, EVERETT, WA 98208(425) 316-5080(425) 316-5025 Get Directions Write a Review

NPPES record last updated: May 9, 2025. Verified against the NPPES registry weekly; last sync: November 08, 2026.

Record update history: May 9, 2025, Mar 21, 2025, Mar 1, 2021 and 1 more (4 updates tracked since 2021).

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 1912158023), doing business as Pmg Nw Wa Reconstructive & Plastic Surgery, is a healthcare organization registered as a plastic surgery in Everett, Washington and active in the NPI registry since October 2008. The organization lists Donald Wayne Anderson, Assistant Secretary Of Enrollments, as its authorized official.

NPPES Registry Identity

NPI1912158023

Entity TypeOrganization

Primary Taxonomy208200000X

Legal Business NamePROVIDENCE HEALTH & SERVICES - WASHINGTON

Location Address12800 BOTHELL EVERETT HWY, SUITE 260Everett, WA 98208-6642

Mailing AddressPo Box 31001-4114Pasadena, CA 91110-4114 · (425) 358-9786

Phone(425) 316-5080

Fax(425) 316-5025

Organization SubpartNo

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

Enumeration DateOctober 7, 2008

Last NPPES UpdateMay 9, 20254 updates tracked since enumeration

NPPES CertifiedMay 9, 2025

✔ NPI 1912158023 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 6

★ Primary SpecialtyPlastic SurgeryAllopathic & Osteopathic Physicians

Taxonomy Code208200000X

Definition

A plastic surgeon deals with the repair, reconstruction or replacement of physical defects of form or function involving the skin, musculoskeletal system, craniomaxillofacial structures, hand, extremities, breast and trunk and external genitalia or cosmetic enhancement of these areas of the body. Cosmetic surgery is an essential component of plastic surgery. The plastic surgeon uses cosmetic surgical principles to both improve overall appearance and to optimize the outcome of reconstructive procedures. The surgeon uses aesthetic surgical principles not only to improve undesirable qualities of normal structures but in all reconstructive procedures as well.

Also ListedDermatologyTaxonomy 207N00000X

Also ListedDermatology · MOHS-Micrographic SurgeryTaxonomy 207ND0101X

Also ListedDermatology · DermatopathologyTaxonomy 207ND0900X

Also ListedDermatology · Pediatric DermatologyTaxonomy 207NP0225X

Also ListedDermatology · Procedural DermatologyTaxonomy 207NS0135X

12800 BOTHELL EVERETT HWY, Everett, WA 98208

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Other Names 1

Doing Business AsPmg Nw Wa Reconstructive & Plastic Surgery

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 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)

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

Clinicians Billing Medicare Through This Organization

702

Medicare enrollment records show 702 clinicians reassign Medicare billing to Providence Health & Services - Washington, which bills Medicare for the services they deliver. Of these, 21 practice at this address and 363 within 10 miles. Listed here are the 20 practicing nearest to this location.

Clinicians by Medicare Specialty 49

Nurse Practitioner108

Internal Medicine90

Family Practice63

Emergency Medicine61

Neurology56

Hospitalist35

General Surgery29

Cardiovascular Disease (Cardiology)24

41 other specialties236

Nearest to this location (20)

See all 702

Victoria Buchanan, ARNP

Nurse Practitioner

NPI 1699056036

12800 BOTHELL-EVERETT HWY SUITE 180
Everett, WA 98208

(425) 316-5130

✔ PECOS✔ Accepts MedicareSame address

Ward Chow, MD

Internal Medicine

NPI 1669430146

12800 BOTHELL EVERETT HWY
Everett, WA 98208

(425) 316-5130

✔ PECOS✔ Accepts MedicareSame address

Melissa Closs-Brewer, MD

Pediatric Medicine

NPI 1467553529

12800 BOTHELL EVERETT HWY SUITE 190
Everett, WA 98208

(425) 316-5160

✔ PECOSSame address

Celia Dastvan, MD

Pediatric Medicine

NPI 1346341377

12800 BOTHELL EVERETT HWY SUITE 190
Everett, WA 98208

(425) 316-5160

✔ PECOS✔ Accepts MedicareSame address

Karine Davis, ARNP

Nurse Practitioner

NPI 1518269059

12800 BOTHELL EVERETT HWY SUITE 260
Everett, WA 98208

(425) 316-5080

✔ PECOS✔ Accepts MedicareSame address

James Edwards, MD

Plastic and Reconstructive Surgery

NPI 1679680441

12800 BOTHELL EVERETT HWY SUITE 260
Everett, WA 98208

(425) 316-5080

✔ PECOS✔ Accepts MedicareSame address

Josh Krawczyk, LMHC

Mental Health Counselor

NPI 1194470013

12800 BOTHELL EVERETT HWY
Everett, WA 98208

(425) 316-5062

✔ PECOS✔ Accepts MedicareSame address

Judith Kuo, MD

Pathology

NPI 1124129648

12800 BOTHELL EVERETT HWY SUITE 190
Everett, WA 98208

(425) 316-5160

✔ PECOSSame address

Samuel Lien, M.D.

Plastic and Reconstructive Surgery

NPI 1285876185

12800 BOTHELL EVERETT HWY
Everett, WA 98208

(425) 316-5080

✔ PECOS✔ Accepts MedicareSame address

Songyan Mao, MD

Family Practice

NPI 1235160474

12800 BOTHELL EVERETT HWY
Everett, WA 98208

(425) 316-5150

✔ PECOS✔ Accepts MedicareSame address

Norah Nguyen

Family Practice

NPI 1922503366

12800 BOTHELL EVERETT HWY
Everett, WA 98208

(425) 316-5180

✔ PECOS✔ Accepts MedicareSame address

Kristin Obillo, M.D.

Family Practice

NPI 1235399809

12800 BOTHELL EVERETT HWY
Everett, WA 98208

(425) 316-5180

✔ PECOS✔ Accepts MedicareSame address

Ricardo Rodriguez, ARNP

Nurse Practitioner

NPI 1992858377

12800 BOTHELL EVERETT HWY
Everett, WA 98208

(425) 316-5150

✔ PECOS✔ Accepts MedicareSame address

Jeffrey Scott

Plastic and Reconstructive Surgery

NPI 1992814651

12800 BOTHELL EVERETT HWY SUITE 260
Everett, WA 98208

(425) 316-5080

✔ PECOS✔ Accepts MedicareSame address

Tasneem Shikary, MD

Otolaryngology

NPI 1003105867

12800 BOTHELL EVERETT HWY
Everett, WA 98208

(425) 316-5100

✔ PECOS✔ Accepts MedicareSame address

Isha Shrestha, M.D.

Endocrinology

NPI 1477965507

12800 BOTHELL EVERETT HWY STE 250
Everett, WA 98208

(425) 316-5440

✔ PECOS✔ Accepts MedicareSame address

Luann Sines, L.C.S. W

Clinical Social Worker

NPI 1497819718

12800 BOTHELL EVERETT HWY
Everett, WA 98208

(425) 316-5062

✔ PECOSSame address

Jason Soh, MD

Pediatric Medicine

NPI 1689092264

12800 BOTHELL EVERETT HWY
Everett, WA 98208

(425) 316-5160

✔ PECOSSame address

Manaji Suzuki, MD

Pediatric Medicine

NPI 1154412955

12800 BOTHELL EVERETT HWY SUITE 190
Everett, WA 98208

(425) 316-5160

✔ PECOSSame address

Stella Tanedo, MD

Internal Medicine

NPI 1790790582

12800 BOTHELL EVERETT HWY SUITE 180
Everett, WA 98208

(425) 316-5130

✔ PECOS✔ Accepts MedicareSame address

See all 702 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 1912158023. It was assigned to this organization in the NPPES registry on October 7, 2008. The provider is doing business as PMG NW WA Reconstructive & Plastic Surgery.

Where is Providence Health & Services - Washington located?

Providence Health & Services - Washington is located at 12800 Bothell Everett Hwy Suite 260, Everett, WA 98208. The listed phone number is (425) 316-5080.

What is Providence Health & Services - Washington's specialty?

The primary specialty registered for this NPI is Plastic Surgery with taxonomy code 208200000X.

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), 702 clinicians in 49 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 Nurse Practitioner (108), Internal Medicine (90) and Family Practice (63). Of these, 21 practice at this address and 363 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

What insurance does Providence Health & Services - Washington accept?

Health plans from Premera Blue Cross Blue Shield of Alaska 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 9, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 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.