Walla Walla Clinic (professional) - Medicare Primary Care in Walla Walla, WA

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Walla Walla Clinic (professional) is a medicare enrolled primary clinic (Clinic/center) in Walla Walla, Washington. The current practice location for Walla Walla Clinic (professional) is 55 W Tietan St, Walla Walla, Washington. For appointments, you can reach them via phone at (509) 525-3720. The mailing address for Walla Walla Clinic (professional) is 55 W Tietan St, Walla Walla, Washington and phone number is (509) 525-3720.

Walla Walla Clinic (professional) is licensed to practice in (license number ). The clinic also participates in the medicare program and its NPI number is 1780658419. This medical practice accepts medicare insurance (which means this clinic accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance). However, please confirm if they accept your insurance at (509) 525-3720.

Contact Information

Walla Walla Clinic (professional)
55 W Tietan St
Walla Walla
WA 99362-4445
(509) 525-3720
(509) 522-1592

Map and Direction


Primary Care Clinic Profile

Full NameWalla Walla Clinic (professional)
SpecialityClinic/Center
Location55 W Tietan St, Walla Walla, Washington
Authorized Official Name and PositionKevin Michelson (CEO)
Authorized Official Contact5095253720
Accepts Medicare InsuranceYes. This clinic participates in medicare program and accept medicare insurance.

Mailing Address and Practice Location

Mailing AddressPractice Location Address
Walla Walla Clinic (professional)
55 W Tietan St
Walla Walla
WA 99362-4445

Ph: (509) 525-3720		Walla Walla Clinic (professional)
55 W Tietan St
Walla Walla
WA 99362-4445

Ph: (509) 525-3720

NPI Details:

NPI Number1780658419
Provider Enumeration Date02/17/2006
Last Update Date12/23/2025
Certification Date12/23/2025

Medicare PECOS Information:

Medicare PECOS PAC ID2264320837
Medicare Enrollment IDO20040305000581

Medical Identifiers

Medical identifiers for Walla Walla Clinic (professional) such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1780658419NPI-NPPES
208199MedicaidOR
30200OtherWAL&I
7809205MedicaidWA

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
207Q00000XFamily Medicine ()Secondary
261Q00000XClinic/center ()Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Walla Walla Clinic (professional) acts as a billing entity for following providers:
Provider NameTimothy David Kadlecek
Provider TypePractitioner - Diagnostic Radiology
Provider IdentifiersNPI Number: 1538229315
PECOS PAC ID: 5890688352
Enrollment ID: I20040405000710
Provider NameBrian R Mahon
Provider TypePractitioner - Diagnostic Radiology
Provider IdentifiersNPI Number: 1104998962
PECOS PAC ID: 5799778957
Enrollment ID: I20091104000554
Provider NameBrian D Wadley
Provider TypePractitioner - Diagnostic Radiology
Provider IdentifiersNPI Number: 1124076732
PECOS PAC ID: 2264425966
Enrollment ID: I20150310001947
Provider NameMatthew Treinen
Provider TypePractitioner - Diagnostic Radiology
Provider IdentifiersNPI Number: 1093918922
PECOS PAC ID: 1658465943
Enrollment ID: I20210222002936
Provider NameAnne Gerlicher Harned
Provider TypePractitioner - Physician Assistant
Provider IdentifiersNPI Number: 1316597339
PECOS PAC ID: 7012325244
Enrollment ID: I20210427003182
Provider NameChelsea Caruso
Provider TypePractitioner - Diagnostic Radiology
Provider IdentifiersNPI Number: 1659751774
PECOS PAC ID: 8921429267
Enrollment ID: I20210616002469
Provider NameMatthew Kay
Provider TypePractitioner - Diagnostic Radiology
Provider IdentifiersNPI Number: 1033646096
PECOS PAC ID: 7315292430
Enrollment ID: I20210630003330
Provider NameJoseph Marquardt
Provider TypePractitioner - Diagnostic Radiology
Provider IdentifiersNPI Number: 1265753842
PECOS PAC ID: 6800207705
Enrollment ID: I20220509001786
Provider NameMarcus Carr
Provider TypePractitioner - Diagnostic Radiology
Provider IdentifiersNPI Number: 1104280205
PECOS PAC ID: 7416240502
Enrollment ID: I20220811003078

Reviews and Comments

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Phone: 509-876-9707    Fax: 509-955-1339

Medicare Program: Medicare is a federal government program which provides health insurance to people who are 65 or older. This program also covers certain younger people with disabilities (who receive Social Security Disability Insurance - SSDI), and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD.

Medicare Assignment: Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services. Most doctors, providers, and suppliers accept assignment, but you should always check to make sure. Participating providers have signed an agreement to accept assignment for all Medicare-covered services.

NPI Number: The National Provider Identifier (NPI) is a unique identification number for covered health care providers. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA (Health Insurance Portability and Accountability Act).

Our Data: Information on www.medicarelist.com is built using data sources published by Centers for Medicare & Medicaid Services (CMS) under Freedom of Information Act (FOIA). The information disclosed on the NPI Registry are FOIA-disclosable and are required to be disclosed under the FOIA and the eFOIA amendments to the FOIA. There is no way to 'opt out' or 'suppress' the NPPES record data for health care providers with active NPIs.