Individual provider Active NPI

Elizabeth S Hulbrock-Spetzler, RD

  • Pediatric Nutrition Registered Dietitian
  • Seattle, WA
National Provider Identifier
1083066625
Registry record updated Dec 2, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nutrition Registered DietitianTaxonomy code 133VN1004X
License
DI60643233 Issued in WA
Practice address
125 16TH Ave E
Seattle, WA 98112-5211
Phone
(206) 326-3000
Fax
(877) 515-2975
NPI assigned
Jul 7, 2016
Last updated
Dec 2, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 2, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nutrition Registered Dietitian 133VN1004X DI60643233 WA Primary

Addresses

Primary practice location

125 16TH Ave E
Seattle, WA 98112-5211

Mailing address

125 16TH Ave E
Seattle, WA 98112-5211
Phone (206) 326-3000

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwa.kp.org:14430/Interconnect-CE-PRD/wcf/epic.community.hie/xcpdrespondinggatewaysync Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20221213003036 WA Practitioner - Registered Dietitian Or Nutrition Professional 3779952726 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DI60643233WAMDPediatric Nutrition Registered Dietitian

Practice roles

OrganizationSpecialtyStatusNew patients
Kaiser Foundation Health Plan of Washington CurrentSince Oct 2, 2022 Accepting new patients
Kaiser Foundation Health Plan of Washington CurrentSince Oct 2, 2022 Accepting new patients

Locations

125 16th Ave E
Seattle, WA 98112
Phone (206) 326-3530

200 15th Ave E
Seattle, WA 98112
Phone (206) 326-4530

125 16th Ave E
#F112
Seattle, WA 98112

9505 S Steele St
Tacoma, WA 98444
Phone (253) 597-6800

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1467849600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1669939200000",
    "number": "1083066625",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 16TH AVE E",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981125211",
            "telephone_number": "206-326-3000",
            "fax_number": "877-515-2975"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 16TH AVE E",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981125211",
            "telephone_number": "206-326-3000",
            "fax_number": "877-515-2975"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HULBROCK-SPETZLER",
        "first_name": "ELIZABETH",
        "middle_name": "S",
        "name_prefix": "Miss",
        "credential": "RD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-07-07",
        "last_updated": "2022-12-02",
        "certification_date": "2022-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133VN1004X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered, Nutrition, Pediatric",
            "state": "WA",
            "license": "DI60643233",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwa.kp.org:14430/Interconnect-CE-PRD/wcf/epic.community.hie/xcpdrespondinggatewaysync",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "125 16th Ave E",
            "address_2": "CWB F112",
            "city": "Seattle",
            "state": "WA",
            "country_code": "US",
            "postal_code": "981125211",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Seattle, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.