Organization Active NPI

Pacific Wellness Home Visit LLC

  • Primary Care Nurse Practitioner
  • Snohomish, WA
National Provider Identifier
1013767383
Registry record updated Aug 1, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
Legal business name
PACIFIC WELLNESS HOME VISIT LLC
Practice address
108 Union Ave
Snohomish, WA 98290-2971
Phone
(206) 458-5983
NPI assigned
Mar 27, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 1, 2025

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

Authorized official

Name
Dr. Amare Melak Kassahun, ARNPNPI 1538721881
Title
DNP,Arnp
Phone
(206) 458-5983

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X
Primary Care Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LP2300X Primary

Addresses

Primary practice location

108 Union Ave
Snohomish, WA 98290-2971

Mailing address

108 Union Ave
Snohomish, WA 98290-2971
Phone (206) 458-5983

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240717004718 WA Part B Supplier - Clinic/Group Practice 5496290181 Receives reassigned benefits from 1 practitioner
Practice locations: Snohomish, WA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
50D2320692Pacific Wellness Home Visit LLC108 Union Ave, Snohomish, WA 98290Provider-performed microscopyApr 4, 2028

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1711497600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1754006400000",
    "number": "1013767383",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "108 UNION AVE",
            "city": "SNOHOMISH",
            "state": "WA",
            "postal_code": "982902971",
            "telephone_number": "206-458-5983"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "108 UNION AVE",
            "city": "SNOHOMISH",
            "state": "WA",
            "postal_code": "982902971",
            "telephone_number": "206-458-5983"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFIC WELLNESS HOME VISIT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-03-27",
        "last_updated": "2025-08-01",
        "certification_date": "2025-08-01",
        "status": "A",
        "authorized_official_last_name": "KASSAHUN",
        "authorized_official_first_name": "AMARE",
        "authorized_official_middle_name": "MELAK",
        "authorized_official_title_or_position": "DNP,ARNP",
        "authorized_official_telephone_number": "206-458-5983",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "ARNP"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Snohomish, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.