NPIMap

Individual provider Active NPI

Judson E Threlkeld, MD

  • Vascular & Interventional Radiology Physician
  • Lynnwood, WA
National Provider Identifier
1043272941
Registry record updated Aug 30, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular & Interventional Radiology PhysicianTaxonomy code 2085R0204X
License
MD00035176 Issued in WA
Practice address
19020 33Rd Ave W Ste 210
Lynnwood, WA 98036-4748
Phone
(425) 563-1500
Fax
(425) 563-1501
NPI assigned
Apr 5, 2006
Last updated
Aug 30, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 30, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X MD00035176 WA
Vascular & Interventional Radiology Physician 2085R0204X MD00035176 WA Primary

Addresses

Primary practice location

19020 33Rd Ave W Ste 210
Lynnwood, WA 98036-4748

Mailing address

19020 33Rd Ave W Ste 210
Lynnwood, WA 98036-4748
Phone (425) 563-1500

Other identifiers 5

IdentifierTypeStateIssuer
0407495OtherWAL&I-SEATTLE RADIOLOGY
0383447OtherWAL&I- RADIA REST OF WA
227228MedicaidOR
0383457OtherWAL&I-RADIA KING COUNTY
1001058MedicaidWA

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

State licenses

LicenseStateTypeSpecialty
MD00035176WAMDVascular & Interventional Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Arizona State Radiology, PC Diagnostic Radiology Past Accepting new patients
Advanced Medical Imaging Center LLC Diagnostic Radiology Past Accepting new patients
Spokane Radiology Consultants, PS Past Accepting new patients

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1144195200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1567123200000",
    "number": "1043272941",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19020 33RD AVE W STE 210",
            "city": "LYNNWOOD",
            "state": "WA",
            "postal_code": "980364748",
            "telephone_number": "425-563-1500",
            "fax_number": "425-563-1374"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19020 33RD AVE W STE 210",
            "city": "LYNNWOOD",
            "state": "WA",
            "postal_code": "980364748",
            "telephone_number": "425-563-1500",
            "fax_number": "425-563-1501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THRELKELD",
        "first_name": "JUDSON",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-05",
        "last_updated": "2019-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "WA",
            "license": "MD00035176",
            "primary": false
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "WA",
            "license": "MD00035176",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "L&I-SEATTLE RADIOLOGY",
            "identifier": "0407495",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "L&I- RADIA REST OF WA",
            "identifier": "0383447",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "227228",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "L&I-RADIA KING COUNTY",
            "identifier": "0383457",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1001058",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lynnwood, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.