NPIMap

Organization Active NPI

Evergreen Urology Consultants LLC

  • Specialist
  • Issaquah, WA
National Provider Identifier
1013004803
Registry record updated Feb 21, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
EVERGREEN UROLOGY CONSULTANTS LLC
Practice address
6520 226TH PL SE
Suite 205
Issaquah, WA 98027-8969
Phone
(425) 392-8611
Fax
(425) 392-9012
NPI assigned
Oct 5, 2006
Organization subpart
Yes
Parent organization
EVERGREEN UROLOGY CONSULTANTS LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 21, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Lora Plaskon, MD
Title
Owner
Phone
(425) 392-8611

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X Primary

Addresses

Primary practice location

6520 226TH PL SE
Suite 205
Issaquah, WA 98027-8969

Mailing address

6520 226TH PL SE
Suite 205
Issaquah, WA 98027-8969
Phone (425) 392-8611

Other identifiers 1

IdentifierTypeStateIssuer
DG3321OtherWARAILROAD MEDICARE

Other names 1

  • Athena Urolgoy Doing business as

National Provider Directory

National Provider Directory
Part of
Evergreen Urology Conslts

Locations

6520 226th Pl SE
Ste 120
Issaquah, WA 98027
Phone (425) 391-8886

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160006400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1203552000000",
    "number": "1013004803",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6520 226TH PL SE",
            "address_2": "SUITE 205",
            "city": "ISSAQUAH",
            "state": "WA",
            "postal_code": "980278969",
            "telephone_number": "425-392-8611",
            "fax_number": "425-392-9012"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6520 226TH PL SE",
            "address_2": "SUITE 205",
            "city": "ISSAQUAH",
            "state": "WA",
            "postal_code": "980278969",
            "telephone_number": "425-392-8611",
            "fax_number": "425-392-9012"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN UROLOGY CONSULTANTS LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EVERGREEN UROLOGY CONSULTANTS LLC",
        "enumeration_date": "2006-10-05",
        "last_updated": "2008-02-21",
        "status": "A",
        "authorized_official_last_name": "PLASKON",
        "authorized_official_first_name": "LORA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "425-392-8611",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DG3321",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Athena Urolgoy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Issaquah, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.