MEDICARE: COMPASS PAIN CLINIC WASHINGTON PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician

General Provider Information

NPI Number	:	1235081837
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPASS PAIN CLINIC WASHINGTON PC

Provider Business Mailing Address
First Line	:	2021 E COLLEGE WAY STE 210
Second Line	:
City	:	MOUNT VERNON
State	:	WA
Zip	:	98273-2373
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2021 E COLLEGE WAY STE 210
Second Line	:
City	:	MOUNT VERNON
State	:	WA
Zip	:	98273-2373
Country	:	US
Telephone Number	:	503-867-5219
Fax Number	:

Authorized Official
Title or Position	:	MD
Name	:	MATTHEW PETERSON
Credential	:
Telephone Number	:	907-671-1720

Provider Enumeration Date	:	02/14/2026
Last Update Date	:	02/14/2026

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