Active NPI
Peter E Bertozzi Jr., MD
- Anatomic Pathology & Clinical Pathology Physician
- Seatle, WA
National Provider Identifier
1023090180
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anatomic Pathology & Clinical Pathology Physician
- License
- MD00014440
- Practice address
- 1001 Klickitat Way SW
#205
Seatle, WA 98134 - Phone
- (206) 622-7747
- Fax
- (206) 467-1470
- NPI assigned
- Nov 15, 2005
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Anatomic Pathology & Clinical Pathology Physician | 207ZP0102X | MD00014440 | WA | Primary |
Addresses
Primary practice location
1001 Klickitat Way SW
#205
Seatle, WA 98134
Mailing address
PO Box 34245
Seattle, WA 98124-1245
Phone (206) 622-7747
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8481905 | Medicaid | WA | |
| 125694 | Other | WA | ST LABOR AND INDUSTRIES |
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)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Puget Sound Institute of Pathology, PLLC | Past | Accepting new patients | |
| Puget Sound Institute of Pathology PLLC | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Anatomic Pathology Physician
- Seattle, WA
- NPI 1992787030
-
- Clinical Medical Laboratory
- Seattle, WA
- NPI 1720392806
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1132012800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1340236800000",
"number": "1023090180",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 34245",
"city": "SEATTLE",
"state": "WA",
"postal_code": "981241245",
"telephone_number": "206-622-7747",
"fax_number": "206-467-1470"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1001 KLICKITAT WAY SW",
"address_2": "#205",
"city": "SEATLE",
"state": "WA",
"postal_code": "98134",
"telephone_number": "206-622-7747",
"fax_number": "206-467-1470"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BERTOZZI",
"first_name": "PETER",
"middle_name": "E",
"name_suffix": "Jr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-11-15",
"last_updated": "2012-06-21",
"status": "A"
},
"taxonomies": [
{
"code": "207ZP0102X",
"taxonomy_group": "",
"desc": "Pathology, Anatomic Pathology & Clinical Pathology",
"state": "WA",
"license": "MD00014440",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8481905",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ST LABOR AND INDUSTRIES",
"identifier": "125694",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Seatle, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.