NPIMap

Individual provider Active NPI

John B Bak, M.D.

  • Urology Physician
  • Lakewood, WA
National Provider Identifier
1063413938
Registry record updated Nov 24, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
MD00044997 Issued in WA
Practice address
11307 Bridgeport Way SW Ste 217
Lakewood, WA 98499-3024
Phone
(253) 985-6134
Fax
(253) 985-6137
NPI assigned
Aug 2, 2005
Last updated
Nov 24, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 24, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X MD00044997 WA Primary

Addresses

Primary practice location

11307 Bridgeport Way SW Ste 217
Lakewood, WA 98499-3024

Mailing address

11307 Bridgeport Way SW Ste 217
Lakewood, WA 98499-3024
Phone (253) 985-6134

Other identifiers 5

IdentifierTypeStateIssuer
0261681OtherWASTATE L&I
0216025OtherWASTATE L&I
0299315OtherWASTATE L&I
0261684OtherWASTATE L&I
7077449MedicaidWA

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jbak27098@fhsce.catholichealth.net Direct

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
I20050810000776 WA Practitioner - Urology 0547221038 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
Georgetown University School of Medicine, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Franciscan Medical GroupGroup PAC ID 0547173866, 1,400 clinicians

Practice addresses (Care Compare)

11307 Bridgeport Way SW
Suite 217
Lakewood, WA 98499-3024
Phone (253) 985-6134

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Prostate resection15

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Franciscan Medical Group Current Accepting new patients
Franciscan Medical Group CurrentSince Dec 29, 2006 Accepting new patients
Franciscan Medical Group CurrentSince Dec 29, 2006 Accepting new patients
Franciscan Medical Group Past Accepting new patients
Fox Medical Center PastSince Jun 27, 2021 Accepting new patients
Saint Clare Hospital Past Accepting new patients

Locations

11307 Bridgeport Way SW
Ste 217
Lakewood, WA 98499
Phone (253) 985-6134

1112 6th Ave
Ste 300
Tacoma, WA 98405
Phone (206) 272-2224

11311 Bridgeport Way SW
Tacoma, WA 98499
Phone (253) 474-5530

1624 S I St
Ste 204
Tacoma, WA 98405
Phone (253) 272-8441

1812 S J St
Ste 120
Tacoma, WA 98405
Phone (253) 428-2200

4620 Bridgeport Way W
University Place, WA 98466
Phone (253) 564-0170

7210 40th St W
Ste 100
University Place, WA 98466
Phone (253) 564-0170

Networks

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

Organizations & group practices 6

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.

Hospital & facility affiliations 8

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": "1122940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606176000000",
    "number": "1063413938",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11307 BRIDGEPORT WAY SW STE 217",
            "city": "LAKEWOOD",
            "state": "WA",
            "postal_code": "984993024",
            "telephone_number": "253-985-6134",
            "fax_number": "253-985-6137"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11307 BRIDGEPORT WAY SW STE 217",
            "city": "LAKEWOOD",
            "state": "WA",
            "postal_code": "984993024",
            "telephone_number": "253-985-6134",
            "fax_number": "253-985-6137"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAK",
        "first_name": "JOHN",
        "middle_name": "B",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-02",
        "last_updated": "2020-11-24",
        "certification_date": "2020-11-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "WA",
            "license": "MD00044997",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE L&I",
            "identifier": "0261681",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE L&I",
            "identifier": "0216025",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE L&I",
            "identifier": "0299315",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE L&I",
            "identifier": "0261684",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7077449",
            "state": "WA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jbak27098@fhsce.catholichealth.net",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "11307 Bridgeport Way SW Ste 217",
            "city": "Lakewood",
            "state": "WA",
            "country_code": "US",
            "postal_code": "984993024",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Lakewood, WA

Sources for this page

Verify at the official NPI Registry.