NPIMap

Individual provider Active NPI

Samuel M. Donohoe, MD

  • Internal Medicine Physician
  • Mount Vernon, WA
National Provider Identifier
1073806865
Registry record updated Jul 31, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD60465597 Issued in WA
Practice address
1415 E Kincaid St
Hospitalists Office
Mount Vernon, WA 98274-4126
Phone
(360) 416-5750
Fax
(360) 416-5758
NPI assigned
May 26, 2011
Last updated
Jul 31, 2014By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 31, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X A120494 CA
Internal Medicine Physician 207R00000X MD60465597 WA Primary

Addresses

Primary practice location

1415 E Kincaid St
Hospitalists Office
Mount Vernon, WA 98274-4126

Mailing address

1400 E Kincaid St
Attn: Credentialing
Mount Vernon, WA 98274-4127
Phone (360) 428-2500

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
I20140827000816 WA Practitioner - Internal Medicine 1759521727 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Washington School of Medicine, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

310 S Roosevelt St
Goldendale, WA 98620-9201
Phone (509) 486-2151

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Public Hospital Dist No 1 Skagit CurrentSince Aug 13, 2014 Accepting new patients
Grays Harbor Community Hospital Current Accepting new patients
Grays Harbor Community Hospital CurrentSince Jun 1, 2015 Accepting new patients
Grays Harbor House Hospitalist CurrentSince Jun 1, 2015 Accepting new patients
Public Hospital Dist No 1 Skagit CurrentSince Aug 13, 2014 Accepting new patients
Klickitat County Public Hospital District No 1 Past Accepting new patients

Locations

915 Anderson Dr
Aberdeen, WA 98520
Phone (360) 532-8330

1400 E Kincaid St
Mount Vernon, WA 98274
Phone (360) 428-2586

1415 E Kincaid St
Mount Vernon, WA 98274
Phone (360) 416-5750

1415 E Kincaid St
Ofc
Mount Vernon, WA 98274
Phone (360) 416-5750

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 3

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": "1306368000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1406764800000",
    "number": "1073806865",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 E KINCAID ST",
            "address_2": "ATTN: CREDENTIALING",
            "city": "MOUNT VERNON",
            "state": "WA",
            "postal_code": "982744127",
            "telephone_number": "360-428-2500",
            "fax_number": "360-428-6485"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1415 E KINCAID ST",
            "address_2": "HOSPITALISTS OFFICE",
            "city": "MOUNT VERNON",
            "state": "WA",
            "postal_code": "982744126",
            "telephone_number": "360-416-5750",
            "fax_number": "360-416-5758"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DONOHOE",
        "first_name": "SAMUEL",
        "middle_name": "M.",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-05-26",
        "last_updated": "2014-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A120494",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WA",
            "license": "MD60465597",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mount Vernon, WA

Sources for this page

Verify at the official NPI Registry.