Chitchawal Sahatevasukont, N.P.

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

G136472 Issued in IA

Practice address

22722 29TH Dr SE
Ste 100
Bothell, WA 98021-4420

Phone

(770) 363-0793

NPI assigned

Sep 17, 2012

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in GA, WA3 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 3

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Overlake Medical Clinics, LLC

  • Specialist
  • Bellevue, WA
  • NPI 1801828421
  Medicare reassignment NPD
• Overlake Medical Clinics LLC

  • Specialist
  • Bellevue, WA
  • NPI 1871745703
  NPD
• Crossroads Behavioral Health Center

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Creston, IA
  • NPI 1053694802
  NPD
• Partners in Recovery, LLC

  • Clinic/Center
  • Phoenix, AZ
  • NPI 1306698436
  NPD (past)
• United Community Services, Inc.

  • Point of Service
  • West Des Moines, IA
  • NPI 1609998137
  NPD (past)

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

{
    "created_epoch": "1347840000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1588464000000",
    "number": "1053661074",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1920 VARIATIONS DR NE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303291009",
            "telephone_number": "770-363-0793"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22722 29TH DR SE",
            "address_2": "STE 100",
            "city": "BOTHELL",
            "state": "WA",
            "postal_code": "980214420",
            "telephone_number": "770-363-0793"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAHATEVASUKONT",
        "first_name": "CHITCHAWAL",
        "name_prefix": "Mr.",
        "credential": "N.P.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-09-17",
        "last_updated": "2020-05-03",
        "certification_date": "2020-05-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "AZ",
            "license": "AP4663",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "IA",
            "license": "G136472",
            "primary": true
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "GA",
            "license": "RN176776",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Suang Saeturn
• Samar Safdarzadeh Haghighi
• Safeway Inc
• Safeway Inc
• Bert Sagardia
• Brooke Sakowicz, CCC-SLP
• Kaori A Sakurai, MD
• Cynthia Bascara Salazar-Rubio, RN
• Amir H Salehi, DENTURIST L.D.
• Brian Sallin

• Psychiatric/Mental Health Nurse Practitioner in Bothell, WA
• Providers in Bothell, WA by specialty
• Psychiatric/Mental Health Nurse Practitioner in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.