NPIMap

Individual provider Active NPI

Khaled Shaker Elghonemy, MD

  • Internal Medicine Physician
  • Mukilteo, WA
National Provider Identifier
1063790665
Registry record updated May 8, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD60443399 Issued in WA
Practice address
4410 106TH St SW
Mukilteo, WA 98275-4700
Phone
(425) 339-5453
Fax
(425) 252-4441
NPI assigned
Jul 30, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 8, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD60443399 WA Primary

Addresses

Primary practice location

4410 106TH St SW
Mukilteo, WA 98275-4700

Mailing address

7600 Evergreen Way
Everett, WA 98203-6421
Phone (206) 860-5414

Other practice location 1

13020 Meridian Ave S Fl 2
Everett, WA 98208-6468
Phone (425) 357-3700

Other identifiers 1

IdentifierTypeStateIssuer
2036935MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA, TX2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20140714001397 WA Practitioner - Internal Medicine 7012132780 Reassigns benefits to 3 organizations
I20260409000877 TX Practitioner - Internal Medicine 7012132780 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Optum Care Washington PLLCGroup PAC ID 6406752153, 684 clinicians
The Polyclinic PLLCGroup PAC ID 2163328196, 364 clinicians

Practice addresses (Care Compare)

4410 106TH St SW
Mukilteo, WA 98275-4700
Phone (425) 493-6000

904 7TH Ave
Seattle, WA 98104-1132
Phone (206) 309-1760

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD60443399WAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Optum Care Washington PLLC Internal Medicine CurrentSince Jan 13, 2025 Accepting new patients
The Polyclinic PLLC Internal Medicine CurrentSince Jan 7, 2019 Accepting new patients
Signify Health Medical Associates, PLLC CurrentSince Apr 7, 2024 Accepting new patients
The Polyclinic PLLC Internal Medicine Current Accepting new patients
Optum Care Washington PLLC Internal Medicine CurrentSince Jan 13, 2025 Accepting new patients
Optum Care Washington PLLC Past Accepting new patients

Locations

4055 Valley View Ln
Ste 400
Dallas, TX 75244
Phone (469) 466-7037

1330 Rockefeller Ave
Everett, WA 98201
Phone (425) 258-3903

13020 Meridian Ave S
Fl 2
Everett, WA 98208
Phone (425) 357-3700

13020 Meridian Ave S
Everett, WA 98208
Phone (425) 357-3700

4410 106th St SW
Mukilteo, WA 98275
Phone (206) 388-6000

711 Capitol Way S
Ste 204
Olympia, WA 98501
Phone (602) 499-5303

904 7th Ave
Seattle, WA 98104
Phone (206) 223-6487

1145 Broadway
Seattle, WA 98122

1201 N 175th St
Shoreline, WA 98133
Phone (425) 339-4299

1812 S J St
Ste 102
Tacoma, WA 98405
Phone (253) 552-4900

Interoperability endpoints

  • Direct secure messaging: kelghonemy1068041@wm.providencedirect.org
  • Direct secure messaging: khaled.elghonemy.1@30393.direct.athenahealth.com
  • Direct secure messaging: kelghonemy21884@direct.tecmc.com

Organizations & group practices 7

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 9

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": "1311984000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1778198400000",
    "number": "1063790665",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7600 EVERGREEN WAY",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982036421",
            "telephone_number": "206-860-5414"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4410 106TH ST SW",
            "city": "MUKILTEO",
            "state": "WA",
            "postal_code": "982754700",
            "telephone_number": "425-339-5453",
            "fax_number": "425-252-4441"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "13020 Meridian Ave S Fl 2",
            "address_purpose": "LOCATION",
            "city": "Everett",
            "state": "WA",
            "postal_code": "982086468",
            "country_code": "US",
            "telephone_number": "425-357-3700",
            "fax_number": "425-357-3701",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ELGHONEMY",
        "first_name": "KHALED",
        "middle_name": "SHAKER",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-07-30",
        "last_updated": "2026-05-08",
        "certification_date": "2026-05-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WA",
            "license": "MD60443399",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2036935",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mukilteo, WA

Sources for this page

Verify at the official NPI Registry.