| Jefferson Healthcare | |
|
834 Sheridan St Port Townsend WA 98368-2443 | |
| (360) 385-2200 | |
| (360) 379-4381 |
| Full Name | Jefferson Healthcare |
|---|---|
| Speciality | General Acute Care Hospital |
| Location | 834 Sheridan St, Port Townsend, Washington |
| Authorized Official Name and Position | Mike Glenn (CEO) |
| Authorized Official Contact | 3603852200 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jefferson Healthcare 834 Sheridan St Port Townsend WA 98368-2443 Ph: (360) 385-2200 | Jefferson Healthcare 834 Sheridan St Port Townsend WA 98368-2443 Ph: (360) 385-2200 |
| NPI Number | 1356492953 |
|---|---|
| Provider Enumeration Date | 01/12/2007 |
| Last Update Date | 10/29/2020 |
| Medicare PECOS PAC ID | 4789593708 |
|---|---|
| Medicare Enrollment ID | O20031111000542 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356492953 | NPI | - | NPPES |
| 7173404 | Medicaid | WA | |
| 8865428 | Other | WA | MEDICARE PTAN |
| 3301900 | Medicaid | WA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Secondary |
| 282NC0060X | General Acute Care Hospital - Critical Access | 282NC0060X (Washington) | Primary |
| Provider Name | Daniel E Nadig |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1154343135 PECOS PAC ID: 7113824780 Enrollment ID: I20031216000911 |
| Provider Name | Shannan C Kirchner |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1518994615 PECOS PAC ID: 7012805914 Enrollment ID: I20040310000693 |
| Provider Name | Colum P Tinley |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1801855978 PECOS PAC ID: 5799675294 Enrollment ID: I20040401001133 |
| Provider Name | Ann E Murphy |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1033282066 PECOS PAC ID: 4183610058 Enrollment ID: I20040424000227 |
| Provider Name | Laurence Cambron |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1417924242 PECOS PAC ID: 6103815360 Enrollment ID: I20040511001579 |
| Provider Name | Muneer J Desai |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1376516021 PECOS PAC ID: 4688645591 Enrollment ID: I20040804000603 |
| Provider Name | Scott D Harrison |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1558335372 PECOS PAC ID: 9931170859 Enrollment ID: I20040804000707 |
| Provider Name | David Harris |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1154373553 PECOS PAC ID: 2860464179 Enrollment ID: I20040809000160 |
| Provider Name | Dimitri D Kuznetsov |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1659473825 PECOS PAC ID: 1456327808 Enrollment ID: I20040907001073 |
| Provider Name | Kevin R Bowman |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1245269638 PECOS PAC ID: 9830167527 Enrollment ID: I20040921000304 |
| Provider Name | Alexander P Kallas |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1548324577 PECOS PAC ID: 8820066483 Enrollment ID: I20040921000937 |
| Provider Name | Jane E Albee |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104857838 PECOS PAC ID: 5698739621 Enrollment ID: I20041118000512 |
| Provider Name | Andrew C Peet |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1740237619 PECOS PAC ID: 6204893290 Enrollment ID: I20041210000752 |
| Provider Name | Kent C Smith |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1306873302 PECOS PAC ID: 9537127675 Enrollment ID: I20041221000779 |
| Provider Name | Jakdej J Nikomborirak |
|---|---|
| Provider Type | Practitioner - Sleep Medicine |
| Provider Identifiers | NPI Number: 1477542447 PECOS PAC ID: 8527051879 Enrollment ID: I20041227000267 |
| Provider Name | Frederic B Joseph |
|---|---|
| Provider Type | Practitioner - Interventional Radiology |
| Provider Identifiers | NPI Number: 1609835214 PECOS PAC ID: 5294783320 Enrollment ID: I20050106000811 |
| Provider Name | Sarah Schmidt |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1790739530 PECOS PAC ID: 4284683277 Enrollment ID: I20050117000505 |
| Provider Name | Robert S Butterfield |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1831142132 PECOS PAC ID: 3072562065 Enrollment ID: I20050117000526 |
| Provider Name | Frank W Torres |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1235243825 PECOS PAC ID: 1951398221 Enrollment ID: I20050331000881 |
| Provider Name | Richard H Foxlee |
|---|---|
| Provider Type | Practitioner - Radiation Oncology |
| Provider Identifiers | NPI Number: 1063480358 PECOS PAC ID: 0143258590 Enrollment ID: I20050727001241 |
| Provider Name | Joseph J Mattern |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1023060423 PECOS PAC ID: 6507897402 Enrollment ID: I20050830000445 |
| Provider Name | Rachel L Bickling |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1760587133 PECOS PAC ID: 9335171255 Enrollment ID: I20050831000407 |
| Provider Name | Ajay Kundra |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1649291592 PECOS PAC ID: 5991739781 Enrollment ID: I20050921000576 |
| Provider Name | Jennifer W Carl |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1356341697 PECOS PAC ID: 7911922778 Enrollment ID: I20051011000281 |
| Provider Name | Kurt A Norman |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1255306825 PECOS PAC ID: 0042226391 Enrollment ID: I20060224000055 |
| Provider Name | James C Wallace |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1801864327 PECOS PAC ID: 9436166048 Enrollment ID: I20060310000113 |
| Provider Name | Claire L Haycox |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1457309908 PECOS PAC ID: 2062302318 Enrollment ID: I20060321000290 |
| Provider Name | Thomas Kummet |
|---|---|
| Provider Type | Practitioner - Medical Oncology |
| Provider Identifiers | NPI Number: 1649222720 PECOS PAC ID: 5395740542 Enrollment ID: I20060922000206 |
| Provider Name | Christopher R Becker |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1639183460 PECOS PAC ID: 5395740385 Enrollment ID: I20060926000216 |
| Provider Name | Michael S Fortney |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1891721858 PECOS PAC ID: 0840277182 Enrollment ID: I20061026000014 |
| Provider Name | Feiyu Xue |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1225008568 PECOS PAC ID: 5395727580 Enrollment ID: I20061026000150 |
| Provider Name | Renee Ms Schroetlin |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1407960339 PECOS PAC ID: 5193725141 Enrollment ID: I20061222000150 |
| Provider Name | Molly Hong |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1265485353 PECOS PAC ID: 4385608322 Enrollment ID: I20070105000393 |
| Provider Name | Jeremy A Idjadi |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1578659264 PECOS PAC ID: 8527068709 Enrollment ID: I20070111000683 |
| Provider Name | Kari C Heistand |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1043301930 PECOS PAC ID: 5698775898 Enrollment ID: I20070112000109 |
| Provider Name | Matthew A Voorsanger |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1073506143 PECOS PAC ID: 7618875253 Enrollment ID: I20070202000038 |
| Provider Name | Tobun Cheung |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1508895509 PECOS PAC ID: 1557339108 Enrollment ID: I20070206000670 |
| Provider Name | Helene W Lhamon |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1164448833 PECOS PAC ID: 8224068531 Enrollment ID: I20070226000159 |
| Provider Name | Todd A Erickson |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1952455503 PECOS PAC ID: 9133224538 Enrollment ID: I20070413000059 |
| Provider Name | Stephen J Churchley |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1285602706 PECOS PAC ID: 0749200632 Enrollment ID: I20070531000520 |
| Provider Name | Molly Parker |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1124224225 PECOS PAC ID: 8729179940 Enrollment ID: I20070802000197 |
| Provider Name | Edward W Eissmann |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1558466029 PECOS PAC ID: 1658451406 Enrollment ID: I20080107000037 |
| Provider Name | David D Tinker |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1558386516 PECOS PAC ID: 5890683643 Enrollment ID: I20080225000210 |
| Provider Name | Sarah E Kirkegaard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972771335 PECOS PAC ID: 3274610589 Enrollment ID: I20080411000038 |
| Provider Name | Jesse J Kincaid |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1093835829 PECOS PAC ID: 6103997333 Enrollment ID: I20080616000790 |
| Provider Name | Kelley L Cline |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1497941504 PECOS PAC ID: 4486729605 Enrollment ID: I20080821000490 |
| Provider Name | Oscar M Busso |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1508887449 PECOS PAC ID: 5092777664 Enrollment ID: I20090529000113 |
| Provider Name | Lance D Griffin |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1710132451 PECOS PAC ID: 5890785083 Enrollment ID: I20090626000215 |
| Provider Name | Daniel Dt Pham |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1568658524 PECOS PAC ID: 5092880633 Enrollment ID: I20090717000305 |
| Provider Name | Frank S Rosenbloom |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1306924691 PECOS PAC ID: 9234288416 Enrollment ID: I20090730000151 |
| Provider Name | Brian P Barger |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164437588 PECOS PAC ID: 3870402720 Enrollment ID: I20091028000840 |
| Provider Name | Holly W Peng |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1356465124 PECOS PAC ID: 1153513270 Enrollment ID: I20101007001142 |
| Provider Name | Paul E Naumann |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1639391501 PECOS PAC ID: 5991852188 Enrollment ID: I20101014000332 |
| Provider Name | Jay A Lawrence |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1659455095 PECOS PAC ID: 8527956382 Enrollment ID: I20110203001123 |
| Provider Name | Todd J Carlson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1164475554 PECOS PAC ID: 6800076514 Enrollment ID: I20110214000392 |
| Provider Name | Shannon Servin Obert |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1285861989 PECOS PAC ID: 5294911186 Enrollment ID: I20110510000545 |
| Provider Name | Kristin Ruth Grant |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1831361542 PECOS PAC ID: 0345313623 Enrollment ID: I20110519000314 |
| Provider Name | Matthew B Crowell |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1518123132 PECOS PAC ID: 3375712359 Enrollment ID: I20110808000813 |
| Provider Name | Charles W Schott |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407043235 PECOS PAC ID: 2062683980 Enrollment ID: I20110923000561 |
| Provider Name | Gary C Forbes |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1407808538 PECOS PAC ID: 6608033329 Enrollment ID: I20120208000736 |
| Provider Name | John V Murray |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1538117700 PECOS PAC ID: 8527057405 Enrollment ID: I20120803000746 |
| Provider Name | Deborah M Abrams |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1902974835 PECOS PAC ID: 5991955064 Enrollment ID: I20121025000665 |
| Provider Name | Angela M Pieratt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457603441 PECOS PAC ID: 5294987467 Enrollment ID: I20121214000435 |
| Provider Name | Stephen T Erickson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1932259587 PECOS PAC ID: 8628069879 Enrollment ID: I20130128000136 |
| Provider Name | Nicholas Shawnik |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1396993499 PECOS PAC ID: 5991849994 Enrollment ID: I20130218000489 |
| Provider Name | Anne E Koomen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629351317 PECOS PAC ID: 9234384439 Enrollment ID: I20130219000062 |
| Provider Name | Steven W Moll |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1558383778 PECOS PAC ID: 6204085202 Enrollment ID: I20130314000438 |
| Provider Name | Ivan Mendez-escobar |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1548580822 PECOS PAC ID: 0840435806 Enrollment ID: I20130925000874 |
| Provider Name | Lusana Schutz |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1972731628 PECOS PAC ID: 7810152618 Enrollment ID: I20140120000588 |
| Provider Name | Laura R Wulff |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1861629776 PECOS PAC ID: 1153507207 Enrollment ID: I20140224000631 |
| Provider Name | Alex Herzberg |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1629085519 PECOS PAC ID: 4183785462 Enrollment ID: I20140508001708 |
| Provider Name | Michael M Johns |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1679882534 PECOS PAC ID: 3577787910 Enrollment ID: I20140605000200 |
| Provider Name | Mona Shawky |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1861711210 PECOS PAC ID: 4284877903 Enrollment ID: I20140710001057 |
| Provider Name | Catherine R Mank |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1285863431 PECOS PAC ID: 8426294869 Enrollment ID: I20140820001125 |
| Provider Name | Tracie L Harris |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1184608366 PECOS PAC ID: 0648283788 Enrollment ID: I20141010002416 |
| Provider Name | Judith Mccarty Gayne |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1881823375 PECOS PAC ID: 7618108028 Enrollment ID: I20141217000552 |
| Provider Name | Mitra Jafari |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1528232014 PECOS PAC ID: 4688841869 Enrollment ID: I20150102001397 |
| Provider Name | Mark N Cherniack |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1982093472 PECOS PAC ID: 3072830991 Enrollment ID: I20150402000177 |
| Provider Name | David P Frick |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1356383004 PECOS PAC ID: 0941527824 Enrollment ID: I20150403000003 |
| Provider Name | Matthew Donavon Petta |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1376569954 PECOS PAC ID: 7618985516 Enrollment ID: I20150619002355 |
| Provider Name | Ronald William Irick |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1245592377 PECOS PAC ID: 9638484132 Enrollment ID: I20150812008521 |
| Provider Name | Reina H Parker |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1922269539 PECOS PAC ID: 9335333236 Enrollment ID: I20160122000658 |
| Provider Name | Scott B Hankinson |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1386610178 PECOS PAC ID: 5193700045 Enrollment ID: I20160127001501 |
| Provider Name | Sarah J Irick |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952767865 PECOS PAC ID: 2466758362 Enrollment ID: I20160302001459 |
| Provider Name | Gene L Robinson |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1023034139 PECOS PAC ID: 1052311966 Enrollment ID: I20160324001895 |
| Provider Name | Elizabeth Anne Olinger |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043375652 PECOS PAC ID: 4082699137 Enrollment ID: I20160425000877 |
| Provider Name | Matthew K Fitzpatrick |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1043451180 PECOS PAC ID: 2567644032 Enrollment ID: I20160627000420 |
| Provider Name | Olivia Haesloop |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1386910420 PECOS PAC ID: 2466771456 Enrollment ID: I20160804002469 |
| Provider Name | Stefanie G Walker Leu |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699053041 PECOS PAC ID: 4688840010 Enrollment ID: I20170307001402 |
| Provider Name | Leah R Layman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790189256 PECOS PAC ID: 2860714730 Enrollment ID: I20170606000923 |
| Provider Name | Alexander Eddy Pratt |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1740609106 PECOS PAC ID: 0446576508 Enrollment ID: I20170622002098 |
| Provider Name | Mary A Allen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164726915 PECOS PAC ID: 6002189164 Enrollment ID: I20170912001412 |
| Provider Name | David M Schwartz |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1407119761 PECOS PAC ID: 6103182316 Enrollment ID: I20171103001122 |
| Provider Name | Chrystal D Schwartz |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1326301680 PECOS PAC ID: 1153619119 Enrollment ID: I20171227001211 |
| Provider Name | Frank B Magill |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1649222852 PECOS PAC ID: 8820229032 Enrollment ID: I20180111001159 |
| Provider Name | Linda J Calderwood |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114300241 PECOS PAC ID: 2365758265 Enrollment ID: I20180124001685 |
| Provider Name | Sarah C Heiner |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1295754174 PECOS PAC ID: 4082693122 Enrollment ID: I20180201000031 |
| Provider Name | Kari L Griffin-harte |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336494509 PECOS PAC ID: 2961657838 Enrollment ID: I20180312000914 |
| Provider Name | Amy K Grace |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073948923 PECOS PAC ID: 7315177938 Enrollment ID: I20180314001625 |
| Provider Name | Denise Sample |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083919898 PECOS PAC ID: 5395909683 Enrollment ID: I20180326000725 |
| Provider Name | Jong Liu |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1306952957 PECOS PAC ID: 1254362668 Enrollment ID: I20180419001510 |
| Provider Name | William C Janss |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1558377325 PECOS PAC ID: 7911915525 Enrollment ID: I20180802002330 |
| Provider Name | Annaliisa Mcglinn |
|---|---|
| Provider Type | Practitioner - Radiation Oncology |
| Provider Identifiers | NPI Number: 1063506590 PECOS PAC ID: 8224085410 Enrollment ID: I20181115002365 |
| Provider Name | Katie L Ernst |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851811327 PECOS PAC ID: 3274804570 Enrollment ID: I20181126000338 |
| Provider Name | Christine M Doyle |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790268852 PECOS PAC ID: 3274887534 Enrollment ID: I20181126003809 |
| Provider Name | Mary T Towns |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174713788 PECOS PAC ID: 9931289733 Enrollment ID: I20181128003331 |
| Provider Name | Aaron T Yu |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1386718625 PECOS PAC ID: 6800082918 Enrollment ID: I20181210003241 |
| Provider Name | Martin H Ellbogen |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1578580593 PECOS PAC ID: 2062413917 Enrollment ID: I20181210003422 |
| Provider Name | Sergei Pavlov |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1649215187 PECOS PAC ID: 4587665666 Enrollment ID: I20181214001413 |
| Provider Name | Shayna M Lemke |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1104137058 PECOS PAC ID: 4082861794 Enrollment ID: I20190109000262 |
| Provider Name | Kelsea Peterman |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1194163915 PECOS PAC ID: 2860738663 Enrollment ID: I20190116000920 |
| Provider Name | Sandra M Demars |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1811212749 PECOS PAC ID: 3173820156 Enrollment ID: I20190125002713 |
| Provider Name | Shawn Lewis Call |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1720421662 PECOS PAC ID: 8921240813 Enrollment ID: I20190408002748 |
| Provider Name | Elizabeth A Yeater |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093367005 PECOS PAC ID: 4082943949 Enrollment ID: I20190903001669 |
| Provider Name | Gregory B Smith |
|---|---|
| Provider Type | Practitioner - Hematology |
| Provider Identifiers | NPI Number: 1265408447 PECOS PAC ID: 2365340452 Enrollment ID: I20190911000746 |
| Provider Name | Allen C Rassa |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1932465424 PECOS PAC ID: 4688805500 Enrollment ID: I20191030002359 |
| Provider Name | Lee Holder |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1447662325 PECOS PAC ID: 1355773672 Enrollment ID: I20191107000402 |
| Provider Name | Joseph M Meyerson |
|---|---|
| Provider Type | Practitioner - Plastic And Reconstructive Surgery |
| Provider Identifiers | NPI Number: 1588919617 PECOS PAC ID: 4284878208 Enrollment ID: I20191108001178 |
| Provider Name | Coreen J Williams |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740236561 PECOS PAC ID: 0244240141 Enrollment ID: I20191119002908 |
| Provider Name | Haley E Hoffner |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1952755746 PECOS PAC ID: 4486986114 Enrollment ID: I20191216001729 |
| Provider Name | Heide Chaney |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215439989 PECOS PAC ID: 8426313982 Enrollment ID: I20200109001209 |
| Provider Name | Umberto Orazi |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1124063417 PECOS PAC ID: 9436152667 Enrollment ID: I20200128001200 |
| Provider Name | Carl G. Weber |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1073517827 PECOS PAC ID: 5294625554 Enrollment ID: I20200330001684 |
| Provider Name | Reyne Lee-arbuckle Yamane |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952866170 PECOS PAC ID: 0547690042 Enrollment ID: I20200424000712 |
| Provider Name | Andrew P Robbins |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1477970382 PECOS PAC ID: 6305137837 Enrollment ID: I20200501000260 |
| Provider Name | Jason E Rogers |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1366885840 PECOS PAC ID: 4789927260 Enrollment ID: I20200501002508 |
| Provider Name | Carol Venable |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1285665760 PECOS PAC ID: 4880697861 Enrollment ID: I20200528000830 |
| Provider Name | Paul Grant Craig |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1699193326 PECOS PAC ID: 7810292943 Enrollment ID: I20200619002151 |
| Provider Name | Christopher Manik |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1730114059 PECOS PAC ID: 2769389089 Enrollment ID: I20200813001449 |
| Provider Name | Asif Luqman |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1629451489 PECOS PAC ID: 1759628803 Enrollment ID: I20200928002701 |
| Provider Name | Katherine Biccum |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1407236912 PECOS PAC ID: 1658689476 Enrollment ID: I20201016001573 |
| Provider Name | Christine Skorberg |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1073574620 PECOS PAC ID: 8628218690 Enrollment ID: I20201029001710 |
| Provider Name | Eric W Wallace |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1578502191 PECOS PAC ID: 3577506690 Enrollment ID: I20210317001829 |
| Provider Name | Macie Ann Booker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033708920 PECOS PAC ID: 2264849967 Enrollment ID: I20210324003341 |
| Provider Name | Ethan M Ross |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1780848507 PECOS PAC ID: 0547419681 Enrollment ID: I20210630002694 |
| Provider Name | Nazanin Kaatz |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1720366883 PECOS PAC ID: 8325301021 Enrollment ID: I20211019002329 |
| Provider Name | Samuel M Shirk |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1760779698 PECOS PAC ID: 8426373259 Enrollment ID: I20211102001348 |
| Provider Name | Larry M Cai |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1316301823 PECOS PAC ID: 8628347291 Enrollment ID: I20211227000124 |
| Provider Name | Elyse Blum |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1326574435 PECOS PAC ID: 4082951850 Enrollment ID: I20220610000798 |
| Provider Name | Robert L Mcgruder |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336677731 PECOS PAC ID: 9638571920 Enrollment ID: I20220714001204 |
| Provider Name | Erica Tirado |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1407254568 PECOS PAC ID: 3173817160 Enrollment ID: I20220823001937 |
| Provider Name | Jennifer Lynn Sayles |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316678352 PECOS PAC ID: 4789068669 Enrollment ID: I20220825003112 |
| Provider Name | Pamela Ruth Ator |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1780656488 PECOS PAC ID: 0345210613 Enrollment ID: I20220906002463 |
| Provider Name | Mikhail Perlov |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1184820359 PECOS PAC ID: 9638310287 Enrollment ID: I20220907002961 |
| Provider Name | Jeremiah Brewer |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1679968697 PECOS PAC ID: 8426366378 Enrollment ID: I20221207003154 |
| Provider Name | Kory Albert |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1326148859 PECOS PAC ID: 2264339803 Enrollment ID: I20230301001135 |
| Provider Name | Kathleen Danella Sayles |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053020891 PECOS PAC ID: 4981077054 Enrollment ID: I20230322002420 |
| Provider Name | Tarig Ahmed |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1669705471 PECOS PAC ID: 5294981437 Enrollment ID: I20230406002277 |
| Provider Name | Teresa J Lord |
|---|---|
| Provider Type | Practitioner - Medical Oncology |
| Provider Identifiers | NPI Number: 1598885550 PECOS PAC ID: 3779702410 Enrollment ID: I20230414000363 |
| Provider Name | Genevieve D Pate |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376056622 PECOS PAC ID: 8325413628 Enrollment ID: I20230418001301 |
| Provider Name | Casey Medina |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1609304070 PECOS PAC ID: 1153743992 Enrollment ID: I20230427001090 |
| Provider Name | Yamen Homsi |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1598052581 PECOS PAC ID: 5597988345 Enrollment ID: I20230502002431 |
| Provider Name | Haritha Pabbathi |
|---|---|
| Provider Type | Practitioner - Medical Oncology |
| Provider Identifiers | NPI Number: 1215000989 PECOS PAC ID: 4789683210 Enrollment ID: I20230523002356 |
| Provider Name | Mary Hinrichs |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1760043947 PECOS PAC ID: 1153725098 Enrollment ID: I20230628003845 |
| Provider Name | Talya Freudmann |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700195591 PECOS PAC ID: 8628242914 Enrollment ID: I20230713000780 |
| Provider Name | Sean Tanu Dwijendra |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1942797170 PECOS PAC ID: 5698135846 Enrollment ID: I20230719001888 |
| Provider Name | Arthie Jeyakumar |
|---|---|
| Provider Type | Practitioner - Interventional Radiology |
| Provider Identifiers | NPI Number: 1568818292 PECOS PAC ID: 3971983529 Enrollment ID: I20230906000452 |
| Provider Name | Sarah R Abhold |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1962991992 PECOS PAC ID: 7214351808 Enrollment ID: I20231003003371 |
| Provider Name | Caitlin Lund |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1649790403 PECOS PAC ID: 7810266772 Enrollment ID: I20231025001009 |
| Provider Name | Perveen Chattha |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1215385653 PECOS PAC ID: 6800188822 Enrollment ID: I20240216003228 |
| Provider Name | Kimberly Idoko |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1003080896 PECOS PAC ID: 2769605344 Enrollment ID: I20240219003224 |
Jefferson Healthcare Express Clinic Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1274 7th St Ste A, Port Townsend, WA 98368 Phone: 360-385-2204 | |
Quimper Family Medicine Pc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2120 Lawrence St, Port Townsend, WA 98368 Phone: 360-385-3826 Fax: 360-385-3937 | |
Madrona Family Medicine, Ps Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 740 Quincy St, Port Townsend, WA 98368 Phone: 360-440-6220 | |
Jefferson Healthcare Surgical Associates Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1010 Sheridan St Ste 201, Port Townsend, WA 98368 Phone: 360-385-5444 Fax: 360-385-5352 | |
Kala Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 32 Kala Square Pl, Port Townsend, WA 98368 Phone: 360-344-8166 Fax: 360-379-6518 | |
North Star Clinic Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 2120 Lawrence St, Port Townsend, WA 98368 Phone: 360-531-3989 Fax: 360-344-8411 |