NPIMap

Individual provider Active NPI

Jedediah A Kaufman, MD

  • Surgery Physician
  • Shoreline, WA
National Provider Identifier
1043228422
Registry record updated Dec 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
MD00042902 Issued in WA
Practice address
19930 Ballinger Way NE
Shoreline, WA 98155
Phone
(425) 778-2220
NPI assigned
Aug 3, 2006
Last updated
Dec 4, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 4, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X MD00042902 WA Primary

Addresses

Primary practice location

19930 Ballinger Way NE
Shoreline, WA 98155

Mailing address

3610 Ensign Rd NE
Olympia, WA 98506-5025
Phone (360) 493-5252

Other practice location 1

1615 Delaware St
Longview, WA 98632-2367
Phone (360) 501-3500

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040708000490 WA Practitioner - General Surgery 3072591973 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
University of Minnesota Medical School, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
PeacehealthGroup PAC ID 5890689293, 188 clinicians
Valley Medical Group-RentonGroup PAC ID 4183753965, 419 clinicians

Practice addresses (Care Compare)

110 S Apple Blossom Dr
Chelan, WA 98816-8810
Phone (509) 682-3300

1615 Delaware St
Longview, WA 98632-2367
Phone (360) 636-4814

4011 Talbot Rd S
Suite 420
Renton, WA 98055-5791
Phone (425) 228-6076

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Hernia repair - groin (open)1-10
Upper gastrointestinal (GI) endoscopy for acid reflux1-10
Removal of tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD00042902WAMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Chelan County Public Hospital District No 2 CurrentSince Jan 1, 2026 Accepting new patients
Public Hospital District No 2 Skagit County Washington CurrentSince Jul 1, 2018 Accepting new patients
Public Hospital District No 2 Skagit County Washington CurrentSince Jul 1, 2018 Accepting new patients
Multicare Health System CurrentSince Nov 12, 2018 Accepting new patients
Multicare Health System Current Accepting new patients
Chelan County Public Hospital District No 2 CurrentSince Jan 1, 2026 Accepting new patients
Valley Medical Group-Renton Surgery CurrentSince Jun 1, 2024 Accepting new patients
Peacehealth CurrentSince Dec 4, 2025 Accepting new patients
Multicare Health System CurrentSince Nov 12, 2018 Accepting new patients
Public Hospital District No 2 Skagit County Washington Current Accepting new patients
Peacehealth Past Accepting new patients
Jefferson County Public Hospital District No 2 PastSince Dec 1, 2019 Accepting new patients
Public Hospital District 1 of King County Past Accepting new patients

Locations

1211 24th St
Anacortes, WA 98221
Phone (360) 293-3181

1213 24th St
Ste 700
Anacortes, WA 98221
Phone (360) 293-5142

110 S Apple Blossom Dr
Chelan, WA 98816
Phone (509) 682-3300

16850 SE 272nd St
Ste 100
Covington, WA 98042
Phone (253) 395-1971

4700 Point Fosdick Dr
Ste 104
Gig Harbor, WA 98335
Phone (253) 459-7590

1615 Delaware St
Longview, WA 98632
Phone (360) 363-4818

3600 Lind Ave SW
Ste 100
Renton, WA 98057

4011 Talbot Rd S
Ste 420
Renton, WA 98055
Phone (425) 251-1322

Networks

  • WA PPO C-SNP
  • devoted network organization-83621310-88c0-4660-8f8d-b8ea8f4dc04e

Interoperability endpoints

  • Direct secure messaging: jkaufman121135@direct.valleymed.org

Organizations & group practices 13

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

View all 13

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1154563200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1764806400000",
    "number": "1043228422",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3610 ENSIGN RD NE",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985065025",
            "telephone_number": "360-493-5252",
            "fax_number": "360-459-6543"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19930 BALLINGER WAY NE",
            "city": "SHORELINE",
            "state": "WA",
            "postal_code": "98155",
            "telephone_number": "425-778-2220"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1615 Delaware St",
            "address_purpose": "LOCATION",
            "city": "Longview",
            "state": "WA",
            "postal_code": "986322367",
            "country_code": "US",
            "telephone_number": "360-501-3500",
            "fax_number": "360-501-3555",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KAUFMAN",
        "first_name": "JEDEDIAH",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-03",
        "last_updated": "2025-12-04",
        "certification_date": "2025-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "WA",
            "license": "MD00042902",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Shoreline, WA

Sources for this page

Verify at the official NPI Registry.