Bookkeeping and Tax for Seattle Medical Practices
Monthly books, payroll, and tax for Seattle naturopathic, integrative, and concierge practices, handled remotely by enrolled agents.
Running a Practice in Washington
Washington has no state personal income tax, and that changes how a Seattle practice owner should think about taxes. It doesn’t mean the state stays out of your finances. Washington taxes businesses on gross receipts through the business and occupation tax, Seattle has its own city version, and the combined sales tax rate in the city is among the highest in the country. Payroll also carries state premiums for paid family and medical leave and long-term care.
Baker’s Bookkeeping & Tax Services is a family-run bookkeeping and tax practice founded in 1995 in Lenexa, Kansas, and our remote team works with Seattle practices every day. Our enrolled agents take the time to learn how your practice earns money, whether that comes from memberships, visits, or a supplement shelf at the front desk. Then they keep your books in a way that holds up for both the state and the IRS.
Revenue Sorted for B&O
Revenue Sorted for B&O
Washington’s B&O tax is based on what comes in, not what you keep. We sort membership fees, visit charges, lab fees, and product sales into the right categories every month so your state excise return starts from accurate numbers. Books close monthly with a one-page summary you can read in a few minutes.
Sales Tax on Products
Sales Tax on Products
Many Seattle naturopathic and functional medicine practices sell supplements, botanicals, and skincare alongside patient care. Product sales usually carry sales tax while patient care generally does not. We keep the two apart in your books and file sales tax on time so nothing gets missed.
Payroll With State Premiums
Payroll With State Premiums
Staff and provider payroll runs through Gusto, including Washington paid family and medical leave premiums and WA Cares deductions. If you have a provider, biller, or remote assistant living in another state, we handle that payroll too.
Federal Tax Planning
Federal Tax Planning
With no state income tax, nearly all of a Seattle owner’s income tax bill goes to the IRS. Our tax services for physicians and other practice owners look at business structure, a reasonable owner salary, retirement contributions, and the timing of equipment purchases to bring that number down. We plan for next year instead of just filing for last year.
Seattle Practices We Work With
Seattle has one of the strongest naturopathic and integrative medicine communities in the country. Washington licenses naturopathic physicians as primary care providers, Bastyr University trains many of them just north of the city in Kenmore, and the state was among the first to write direct primary care into law. Patients here are comfortable paying for memberships and longer visits, and many physicians have left hospital systems to offer exactly that.
Most of the owners we work with are clinicians running a business for the first time. Our direct care and integrative medicine bookkeeping is built around membership revenue, retail product sales, and the owner pay questions that come up as a practice grows. Marc Eastin, our Chief Information Officer, is a practicing neurosurgeon who also owns a business, so we understand what it’s like to see patients all day and still have a company to run.
Naturopathic Practices
Naturopathic Practices
Naturopathic doctors in Seattle often combine office visits, lab testing, IV therapy, and a supplement dispensary under one roof. We track each source of revenue separately so you can see which parts of the practice are paying for themselves. If you are opening your own clinic, our new practice setup puts your entity, books, and payroll in place before your first patient walks in.
Concierge and Direct Primary Care
Concierge and Direct Primary Care
Membership practices often collect fees in advance, sometimes for a full year at a time. We record that money as it is earned instead of all at once, so your monthly reports show how the practice is actually doing. You can see panel growth and cash flow clearly before you add a provider or expand your hours.
Functional, Hormone, and IV Clinics
Functional, Hormone, and IV Clinics
Cash-pay clinics that sell packages and memberships can look more profitable than they are when prepaid money gets counted too early. We track packages properly and look at what each service earns after supplies and staff time, so your pricing reflects what treatments really cost to deliver.
Therapy and Counseling Groups
Therapy and Counseling Groups
Seattle has a large number of independent therapy and counseling groups. Our President, Marcella Nichols, holds a master’s in clinical psychology and spent seven years in recruiting and HR, so she understands how clinicians are paid and classified. We calculate session-based pay from your existing agreements and make sure every clinician is paid correctly and on time.
Common Questions About This Area
Can you work with a Seattle practice when your office is in Kansas?
Yes. Our remote team works with practice owners across the country, and we have clients in nearly every state. We work with practices in Seattle, Bellevue, Kirkland, Redmond, and throughout Puget Sound. Documents, reviews, and questions are all handled online, so the distance doesn't slow anything down.
Washington has no state income tax. Do I still need tax planning?
Yes. Without a state income tax, almost all of your income tax bill is federal, and federal rates for high-earning practice owners are significant. Decisions about business structure, owner salary, retirement contributions, and equipment purchases still make a large difference. Washington also taxes businesses on gross receipts through the B&O tax, which applies whether or not the practice turns a profit.
Do you file Washington sales tax on supplements and retail products?
Yes. If your practice sells supplements, botanicals, skincare, or other products, we track those sales separately from patient care and file sales tax on the schedule the state assigns you. If you also ship products to patients in other states, we handle those filings as well.
I'm a naturopathic doctor opening my own clinic. Where should I start?
Start with the setup before you see your first patient. We help you choose a business structure, set up QuickBooks Online and Gusto, and organize your books so membership fees, visits, and product sales are tracked correctly from day one. Setup runs from $500 to $5,000 depending on how much needs to be built.
What does monthly bookkeeping cost?
Monthly bookkeeping runs $500 to $1,500 per month depending on transaction volume and complexity. If your books are behind when we start, we bring them current first at 75% of the monthly fee for each month that needs catching up. We'll give you an exact quote after we look at your practice.
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