NPIMap

Individual provider Active NPI

Anawin Sanguankeo, M.D.

  • Nephrology Physician
  • Longview, WA
National Provider Identifier
1043637580
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
MD61239740 Issued in WA
Practice address
1615 Delaware St
Longview, WA 98632-2367
Phone
(360) 414-2730
Fax
(360) 414-2739
NPI assigned
Mar 22, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 036147020 IL
Internal Medicine Physician 207R00000X MD61239740 WA
Nephrology Physician 207RN0300X 036147020 IL
Student in an Organized Health Care Education/Training Program 390200000X
Nephrology Physician 207RN0300X MD61239740 WA Primary

Addresses

Primary practice location

1615 Delaware St
Longview, WA 98632-2367

Mailing address

4101 N Water Tower PL
Mount Vernon, IL 62864-6296
Phone (618) 244-4313

Other practice location 1

1830 E Monument St Fl 4
Baltimore, MD 21287-0020
Phone (410) 955-5268

Other practice location 2

4101 N Water Tower Pl
Mount Vernon, IL 62864
Phone (618) 244-4313

Other practice location 3

4101 N Water Tower Pl
Mount Vernon, IL 62864
Phone (618) 244-4313

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
I20220608002663 WA Practitioner - NephrologyPractitioner - Internal Medicine 8022233170 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
NephrologyAlso: Internal Medicine
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
PeacehealthGroup PAC ID 5890689293, 188 clinicians

Practice addresses (Care Compare)

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

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Peacehealth Internal Medicine CurrentSince Jul 25, 2022 Accepting new patients
National Healthcare of Mt Vernon Inc Past Accepting new patients
Peacehealth Past Accepting new patients

Locations

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

Networks

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

Interoperability endpoints

  • Direct secure messaging: sanguana@yourcarecommunity.org
  • Direct secure messaging: asanguankeo559381@direct.peacehealth.org

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 and National Provider Directory roles.

Hospital & facility affiliations 10

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": "1395446400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1043637580",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4101 N WATER TOWER PL",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628646296",
            "telephone_number": "618-244-4313",
            "fax_number": "410-367-2258"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1615 DELAWARE ST",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "986322367",
            "telephone_number": "360-414-2730",
            "fax_number": "360-414-2739"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1830 E Monument St Fl 4",
            "address_purpose": "LOCATION",
            "city": "Baltimore",
            "state": "MD",
            "postal_code": "212870020",
            "country_code": "US",
            "telephone_number": "410-955-5268",
            "fax_number": "410-367-2258",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4101 N Water Tower Pl",
            "address_purpose": "LOCATION",
            "city": "Mount Vernon",
            "state": "IL",
            "postal_code": "62864",
            "country_code": "US",
            "telephone_number": "618-244-4313",
            "fax_number": "618-244-5348",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4101 N Water Tower Pl",
            "address_purpose": "LOCATION",
            "city": "Mount Vernon",
            "state": "IL",
            "postal_code": "62864",
            "country_code": "US",
            "telephone_number": "618-244-4313",
            "fax_number": "618-244-5348",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SANGUANKEO",
        "first_name": "ANAWIN",
        "name_prefix": "Mr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-03-22",
        "last_updated": "2022-07-21",
        "certification_date": "2022-05-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036147020",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WA",
            "license": "MD61239740",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "IL",
            "license": "036147020",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "WA",
            "license": "MD61239740",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Longview, WA

Sources for this page

Verify at the official NPI Registry.