Active NPI
Edanili Sagun Lacar, M.D.
- Pediatrics Physician
- Sammamish, WA
National Provider Identifier
1003813122
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- K1518
- Practice address
- 2153 E Beaver Lake Dr SE
Sammamish, WA 98075-7921 - Phone
- (956) 793-7888
- NPI assigned
- Jul 5, 2005
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | K1518 | TX | |
| Pediatrics Physician | 208000000X | K1518 | TX | Primary |
Addresses
Primary practice location
2153 E Beaver Lake Dr SE
Sammamish, WA 98075-7921
Mailing address
2153 E Beaver Lake Dr SE
Sammamish, WA 98075-7921
Phone (956) 793-7888
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 124992206;124992205 | Medicaid | TX | |
| K0099021 | Other | TX | DPS |
| 124992207 | Medicaid | TX | |
| K1518 | Other | TX | MEDICAL LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| K1518 | TX | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1120521600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678147200000",
"number": "1003813122",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2153 E BEAVER LAKE DR SE",
"city": "SAMMAMISH",
"state": "WA",
"postal_code": "980757921",
"telephone_number": "956-793-7888"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2153 E BEAVER LAKE DR SE",
"city": "SAMMAMISH",
"state": "WA",
"postal_code": "980757921",
"telephone_number": "956-793-7888"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LACAR",
"first_name": "EDANILI",
"middle_name": "SAGUN",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2005-07-05",
"last_updated": "2023-03-07",
"certification_date": "2021-12-09",
"status": "A"
},
"taxonomies": [
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "TX",
"license": "K1518",
"primary": false
},
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "TX",
"license": "K1518",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "124992206;124992205",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DPS",
"identifier": "K0099021",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "124992207",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICAL LICENSE",
"identifier": "K1518",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Sammamish, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.