Unknown Individual – Orthopaedic Surgery of the Spine Physician, NPI 1255363685

Orthopaedic Surgery of the Spine Physician

Unknown Individual is a healthcare provider. based in Seattle, Washington. specializing in Orthopaedic Surgery of the Spine Physician. They hold a License No. MD00028543 (WA). The NPI Number for Unknown Individual is 1255363685

Main info

Organization

Inactive

47 Years Of Experience

Accepts Medicare Assignment

Name

Unknown Individual

NPI

1255363685

Phone

(206) 264-8100

Address

805 MADISON ST

Deactivation Date

26 December 2024

Doctor Profile

Medical School Name

CLVLND CLINIC LERNER COLLEGE OF MED OF CASE WSTN RSV UNIVERSITY

Secondary Phone

Graduation Year

1979 (47 years ago)

PAC ID

8426940362

Group Practice PAC ID

8527972900

Professional Enrollment ID

I20040623000187

Data current as of

19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology

Experience14

Completeness75

Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

Metropolitan Deli & Cafe, 805, Madison Street, Central Business District, First Hill, Seattle, King County, Washington, 98104, United States
SUITE 901
SEATTLE, WA 981041172
Phone: (206) 264-8100
Fax: (206) 264-8689
Type: Mailing
Rainier Orthopedic Institute, 3801, 5th Street Southeast, Puyallup, Pierce County, Washington, 98374, United States
SUITE 110
PUYALLUP, WA 983742106
Phone: (253) 845-9585
Fax: (253) 435-4785
Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

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Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 98104)

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Provider's Procedures

Unknown Individual performs procedures in Orthopaedic Surgery of the Spine Physician. See the list of HCPCS codes below.

Specialty	Practice State	HCPCS Code	Description	Service Count	Beneficiary Count
ORTHOPEDIC SURGERY	WA	20610	Aspiration and/or injection of large joint or joint capsule	151	88
ORTHOPEDIC SURGERY	WA	27447	Repair of knee joint	27	27
ORTHOPEDIC SURGERY	WA	73562	X-ray of knee, 3 views	155	117

Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.

PAC ID: 8527972900View full group profile

Name	Specialty	State
KAREN L. BOHMKE (MD)	-	WA
DR. WAYNE M WEIL (M.D.)	Orthopedic Surgery, Hand Surgery	WA
MRS. DEBORAH ANN MAZZA (OTR/L, CHT)	Occupational Therapist In Private Practice	WA
DR. LORI OLSON CALDWELL (AU.D.)	-	WA
DR. SPENCER A CORAY (MD)	Orthopedic Surgery, Sports Medicine	WA
DR. PETER J. KINAHAN (M.D.)	-	WA
DR. TRACI SUZANNE GRANSTON (MD)	-	WA
CHAD CARSON MOLONEY (PA-C)	Physician Assistant	WA
KELSEY REGAN PLATT (ARNP)	Nurse Practitioner	WA
STEPHANIE CAROLINE OUELLET (RN, ARNP)	Nurse Practitioner	WA

Reviews

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Frequently asked questions

What is the standard ID for Unknown Individual in the U.S.?

In the U.S., Unknown Individual is identified by NPI 1255363685.

Should I call the clinic if Unknown Individual is inactive here?

If Unknown Individual looks inactive here, cross-check state licensing and the clinic website.

Which specialty label fits Unknown Individual?

NPPES ties Unknown Individual to Orthopaedic Surgery of the Spine Physician in the taxonomy section. Clinical services aligned with this taxonomy classification.

What city is tied to Unknown Individual?

The directory associates Unknown Individual with Seattle, Washington. Check all listed addresses for suites or satellite offices.

Can I verify credentials using only NPI?

NPI confirms identity in the directory; licensure and board certification require separate checks.