Individual provider Active NPI

Justin Lyle Sichula, MD

  • Internal Medicine Physician
  • Vancouver, WA
National Provider Identifier
1013666809
Registry record updated Jun 26, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD61587710 Issued in WA
Practice address
2211 NE 139TH St
Vancouver, WA 98686-2742
Phone
(360) 487-1168
Fax
(503) 413-7361
NPI assigned
Mar 21, 2022
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X WA
Internal Medicine Physician 207R00000X MD61587710 WA Primary

Addresses

Primary practice location

2211 NE 139TH St
Vancouver, WA 98686-2742

Mailing address

109 S Pearl St Apt 2
Ellensburg, WA 98926-4002
Phone (509) 856-4968

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250822000392 WA Practitioner - Internal Medicine 4082092887 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The Vancouver Clinic Inc PSGroup PAC ID 3173436490, 580 clinicians

Practice addresses (Care Compare)

2525 NE 139TH St
Vancouver, WA 98686-2719
Phone (360) 882-2778

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
The Vancouver Clinic Inc PS Internal Medicine Current Accepting new patients
The Vancouver Clinic Inc PS CurrentSince Sep 9, 2025 Accepting new patients
The Vancouver Clinic Inc PS CurrentSince Sep 9, 2025 Accepting new patients
The Vancouver Clinic Pharmacy Past Accepting new patients

Locations

700 NE 87th Ave
Vancouver, WA 98664
Phone (360) 397-1500

2211 NE 139th St
Vancouver, WA 98686
Phone (360) 397-1985

2525 NE 139th St
Vancouver, WA 98686
Phone (360) 397-1500

2525 NE 139th St
Ste 140
Vancouver, WA 98686
Phone (360) 822-2778

Interoperability endpoints

  • Direct secure messaging: jsichula19814@tvc-direct.org
  • Direct secure messaging: justin.sichula.1@18826.direct.athenahealth.com

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1647820800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750896000000",
    "number": "1013666809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "109 S PEARL ST APT 2",
            "city": "ELLENSBURG",
            "state": "WA",
            "postal_code": "989264002",
            "telephone_number": "509-856-4968"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2211 NE 139TH ST",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986862742",
            "telephone_number": "360-487-1168",
            "fax_number": "503-413-7361"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SICHULA",
        "first_name": "JUSTIN",
        "middle_name": "LYLE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-03-21",
        "last_updated": "2025-06-26",
        "certification_date": "2025-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "WA",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WA",
            "license": "MD61587710",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vancouver, WA

Sources for this page

Verify at the official NPI Registry.