Active NPI
Idalis Rae Calvert
- Public Health & General Preventive Medicine Physician
- Port Angeles, WA
National Provider Identifier
1013422757
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Public Health & General Preventive Medicine Physician
- License
- CG60769343
- Practice address
- 243511 W Highway 101
Port Angeles, WA 98363-9472 - Phone
- (360) 565-7264
- Fax
- (360) 452-6274
- NPI assigned
- Dec 4, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Public Health & General Preventive Medicine Physician | 2083P0901X | CG60769343 | WA | Primary |
Addresses
Primary practice location
243511 W Highway 101
Port Angeles, WA 98363-9472
Mailing address
243511 W Highway 101
Port Angeles, WA 98363-9472
Phone (360) 565-7264
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CG60769343 | WA | MD | Public Health & General Preventive Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1512345600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1512345600000",
"number": "1013422757",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "243511 W HIGHWAY 101",
"city": "PORT ANGELES",
"state": "WA",
"postal_code": "983639472",
"telephone_number": "360-565-7264",
"fax_number": "360-452-6274"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "243511 W HIGHWAY 101",
"city": "PORT ANGELES",
"state": "WA",
"postal_code": "983639472",
"telephone_number": "360-565-7264",
"fax_number": "360-452-6274"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CALVERT",
"first_name": "IDALIS",
"middle_name": "RAE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-12-04",
"last_updated": "2017-12-04",
"status": "A"
},
"taxonomies": [
{
"code": "2083P0901X",
"taxonomy_group": "",
"desc": "Preventive Medicine, Public Health & General Preventive Medicine",
"state": "WA",
"license": "CG60769343",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Port Angeles, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.