| Privia Medical Group Washington, Pllc | |
|
55 W Tietan St Walla Walla WA 99362-4445 | |
| (509) 525-3720 | |
| (509) 522-1592 |
| Full Name | Privia Medical Group Washington, Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 55 W Tietan St, Walla Walla, Washington |
| Authorized Official Name and Position | Kevin Michelson (CEO) |
| Authorized Official Contact | 5095253720 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Privia Medical Group Washington, Pllc 55 W Tietan St Walla Walla WA 99362-4445 Ph: (509) 525-3720 | Privia Medical Group Washington, Pllc 55 W Tietan St Walla Walla WA 99362-4445 Ph: (509) 525-3720 |
| NPI Number | 1780658419 |
|---|---|
| Provider Enumeration Date | 02/17/2006 |
| Last Update Date | 10/06/2023 |
| Medicare PECOS PAC ID | 2264320837 |
|---|---|
| Medicare Enrollment ID | O20040309000126 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780658419 | NPI | - | NPPES |
| 208199 | Medicaid | OR | |
| 30200 | Other | WA | L&I |
| 7809205 | Medicaid | WA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Sarah E Scarborough |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649369505 PECOS PAC ID: 1153318514 Enrollment ID: I20040428000036 |
| Provider Name | Marelda M Whitmarsh |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285645390 PECOS PAC ID: 9335138981 Enrollment ID: I20040508000415 |
| Provider Name | Scott T Fry |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1972577195 PECOS PAC ID: 2163491820 Enrollment ID: I20040929000471 |
| Provider Name | Joseph E Wren |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1699750869 PECOS PAC ID: 6901824937 Enrollment ID: I20051108000386 |
| Provider Name | Mark D Frewing |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1902970841 PECOS PAC ID: 7113927252 Enrollment ID: I20070112000535 |
| Provider Name | Edgar A Figueroa |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1487650883 PECOS PAC ID: 5395746275 Enrollment ID: I20070119000094 |
| Provider Name | Ryan T Cornia |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1396869798 PECOS PAC ID: 6002704723 Enrollment ID: I20070824000026 |
| Provider Name | Michael J Wilwand |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1861604217 PECOS PAC ID: 4587750880 Enrollment ID: I20080429000575 |
| Provider Name | Juergen Mueller |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1376636043 PECOS PAC ID: 9234161589 Enrollment ID: I20081106000317 |
| Provider Name | Mark D Haugen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1700890597 PECOS PAC ID: 4486669033 Enrollment ID: I20081215000380 |
| Provider Name | Justin Olswanger |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1033265657 PECOS PAC ID: 5395891477 Enrollment ID: I20090914000813 |
| Provider Name | Jillian R Foglesong Stabile |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1518134964 PECOS PAC ID: 4284777699 Enrollment ID: I20100208000483 |
| Provider Name | Neil E Golan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1407969314 PECOS PAC ID: 9133254238 Enrollment ID: I20100315000616 |
| Provider Name | William Wagner |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1871567941 PECOS PAC ID: 3072516475 Enrollment ID: I20100324000612 |
| Provider Name | Erik C Gryler |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1316911449 PECOS PAC ID: 0446253843 Enrollment ID: I20100415000615 |
| Provider Name | Michael J Wilcox |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1881668655 PECOS PAC ID: 4981786910 Enrollment ID: I20100512000914 |
| Provider Name | Trent D Rogers |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1487619417 PECOS PAC ID: 9638294705 Enrollment ID: I20100913000635 |
| Provider Name | Laura Taylor |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1104894096 PECOS PAC ID: 3375626518 Enrollment ID: I20101029000753 |
| Provider Name | Cynthia B Reese |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1578537205 PECOS PAC ID: 8022202043 Enrollment ID: I20101103000455 |
| Provider Name | Emily Grace Castillo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114261229 PECOS PAC ID: 6709038771 Enrollment ID: I20121221000096 |
| Provider Name | Gregory A Haveman |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1447415773 PECOS PAC ID: 9931335700 Enrollment ID: I20131126001915 |
| Provider Name | W Jeanne Parker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902160559 PECOS PAC ID: 0143454371 Enrollment ID: I20131127001027 |
| Provider Name | Christina R Johanson |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1114350154 PECOS PAC ID: 6103054663 Enrollment ID: I20140109000286 |
| Provider Name | Kristin K Robinson |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1154602738 PECOS PAC ID: 8628298692 Enrollment ID: I20140926000272 |
| Provider Name | James Collins |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1366429383 PECOS PAC ID: 0749176261 Enrollment ID: I20150312002387 |
| Provider Name | Ge Zhao |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1205135092 PECOS PAC ID: 1052631405 Enrollment ID: I20150526002141 |
| Provider Name | Brent Ephraim Winterbottom |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1851787709 PECOS PAC ID: 9739409947 Enrollment ID: I20150528002405 |
| Provider Name | Kevin Robert Andrews |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1174513873 PECOS PAC ID: 9436188430 Enrollment ID: I20150724011961 |
| Provider Name | Jeff M Pryor |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1790045045 PECOS PAC ID: 9436462082 Enrollment ID: I20150724012177 |
| Provider Name | Erika L Rootvik |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407225238 PECOS PAC ID: 5890095301 Enrollment ID: I20151204000556 |
| Provider Name | Nicole A Sharp |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1982902649 PECOS PAC ID: 8325366362 Enrollment ID: I20160316001956 |
| Provider Name | Tyler James Christensen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144606146 PECOS PAC ID: 4789983198 Enrollment ID: I20160505001090 |
| Provider Name | Timothy I O'connor |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1073856043 PECOS PAC ID: 2668783978 Enrollment ID: I20160816001053 |
| Provider Name | Diane D Knight |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851535470 PECOS PAC ID: 1355621855 Enrollment ID: I20161129000390 |
| Provider Name | David James Panther |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1306106547 PECOS PAC ID: 6204132046 Enrollment ID: I20170626002730 |
| Provider Name | Malcolm William Hardy |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1790120145 PECOS PAC ID: 8628347317 Enrollment ID: I20170712002078 |
| Provider Name | Peter Allen Linfoot |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1396777264 PECOS PAC ID: 5991794810 Enrollment ID: I20170825002761 |
| Provider Name | Abby Bettilyon Sorensen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902289838 PECOS PAC ID: 3678880846 Enrollment ID: I20180216001175 |
| Provider Name | Jacob Templin |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1295149052 PECOS PAC ID: 9234354549 Enrollment ID: I20180628001908 |
| Provider Name | Rebekah Dickman |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1083096440 PECOS PAC ID: 7911256094 Enrollment ID: I20180822003164 |
| Provider Name | Claire J Templin |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1750795514 PECOS PAC ID: 8628293941 Enrollment ID: I20181026001573 |
| Provider Name | Danelle Renae Nick |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1245556026 PECOS PAC ID: 6901025238 Enrollment ID: I20190318000394 |
| Provider Name | Cheryl Anna Miller |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1427287572 PECOS PAC ID: 6204264195 Enrollment ID: I20200306000719 |
| Provider Name | Rosemary D Welser |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1508388992 PECOS PAC ID: 5698197168 Enrollment ID: I20200630000748 |
| Provider Name | Laurel Stevens |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1912225160 PECOS PAC ID: 6709194228 Enrollment ID: I20200715001239 |
| Provider Name | Amanda Stepper |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639776370 PECOS PAC ID: 2567877798 Enrollment ID: I20210219001367 |
| Provider Name | Timothy J Davis |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1831539915 PECOS PAC ID: 4880099688 Enrollment ID: I20210817001897 |
| Provider Name | Natalia Dolin |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1013972991 PECOS PAC ID: 5496730673 Enrollment ID: I20220105001740 |
| Provider Name | Dennis Burton |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1043298417 PECOS PAC ID: 7416857388 Enrollment ID: I20220425001765 |
| Provider Name | Andrew L Fluckiger |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1962935593 PECOS PAC ID: 7012349160 Enrollment ID: I20220718002796 |
| Provider Name | Spencer Scott Hendricks |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932830338 PECOS PAC ID: 8224411038 Enrollment ID: I20220811001463 |
| Provider Name | Richard Steinman |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1902880586 PECOS PAC ID: 0749203131 Enrollment ID: I20221027002926 |
| Provider Name | Sendhil Subramanian |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1902883168 PECOS PAC ID: 4981516689 Enrollment ID: I20221028001245 |
| Provider Name | Stephanie Dawn Doud |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861128852 PECOS PAC ID: 2163899360 Enrollment ID: I20221101000617 |
| Provider Name | Merridy R. Dickey |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1629342357 PECOS PAC ID: 3173996204 Enrollment ID: I20230310000337 |
| Provider Name | Russell Jay Leighty |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1780120154 PECOS PAC ID: 6002159035 Enrollment ID: I20230608002630 |
| Provider Name | Mariana Villanueva Lenero |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1194385666 PECOS PAC ID: 4587019708 Enrollment ID: I20231009000832 |
| Provider Name | Craig J Philhower |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285085076 PECOS PAC ID: 5496038416 Enrollment ID: I20240604001193 |
| Provider Name | Fernando Porter |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1669785770 PECOS PAC ID: 0941435986 Enrollment ID: I20240605001931 |
| Provider Name | Shishir Kumar Khetan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1861497372 PECOS PAC ID: 9335199017 Enrollment ID: I20240610002136 |
| Provider Name | David Ko |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1356720049 PECOS PAC ID: 4688975485 Enrollment ID: I20241007001203 |
| Provider Name | Melanie Lieblang |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508392952 PECOS PAC ID: 2365714995 Enrollment ID: I20241231002208 |
| Provider Name | Qumara Hill-smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871906024 PECOS PAC ID: 5597987594 Enrollment ID: I20250130002237 |
| Provider Name | Sergiy Berezhnoy |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1881164978 PECOS PAC ID: 3274063656 Enrollment ID: I20250214000904 |
| Provider Name | Ana Guadalupe Torres |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1750893723 PECOS PAC ID: 9638699267 Enrollment ID: I20250225003670 |
Yakima Valley Farm Workers Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1120 W Rose St, Walla Walla, WA 99362 Phone: 509-525-0247 | |
Im Locum Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1025 S 2nd Ave, Walla Walla, WA 99362 Phone: 702-453-3799 Fax: 702-453-5741 | |
Blue Mountain Medical Goup, Pllc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1111 S 2nd Ave, Walla Walla, WA 99362 Phone: 509-522-0100 Fax: 509-527-8010 | |
Providence Health & Services - Washington Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 380 Chase Avenue, Pmg Se Wa Rural Health Clinic, Walla Walla, WA 99362 Phone: 509-526-3333 Fax: 509-526-8402 | |
Ideal Option, Pllc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 405 W Main St, Walla Walla, WA 99362 Phone: 877-522-1275 Fax: 509-491-3031 | |
Choice Family Medicine Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 135 Thorne St, Walla Walla, WA 99362 Phone: 509-876-9707 Fax: 509-955-1339 | |
Providence Health & Services - Washington Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 380 Chase Ave, Walla Walla, WA 99362 Phone: 509-526-3333 |