NPIMap

Individual provider Active NPI

David Keisho Su, M.D.

  • Neurological Surgery Physician
  • Seattle, WA
National Provider Identifier
1083863005
Registry record updated Mar 19, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurological Surgery PhysicianTaxonomy code 207T00000X
License
MD60489943 Issued in WA
Practice address
900 Lenora St
501
Seattle, WA 98121-2720
Phone
(559) 260-0047
NPI assigned
Sep 15, 2008
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 19, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurological Surgery Physician 207T00000X MD60489943 WA Primary

Addresses

Primary practice location

900 Lenora St
501
Seattle, WA 98121-2720

Mailing address

1959 NE Pacific Street
Department of Neurological Surgery
Seattle, WA 98195
Phone (206) 543-3570

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address dsu1112143@wm.providencedirect.org

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
I20151104001416 WA Practitioner - Neurosurgery 4082924048 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Neurosurgery
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Providence Health and Services- WashingtonGroup PAC ID 8325100480, 527 clinicians

Practice addresses (Care Compare)

1717 13TH St
Suite 401
Everett, WA 98201-1621
Phone (425) 297-6400

Hospital & facility affiliations

  • Providence Regional Medical Center Everett Hospital, Everett, WA, CCN 500014
  • Swedish Edmonds Hospital Hospital, Edmonds, WA, CCN 500026
  • Whidbeyhealth Medical Center Hospital, Coupeville, WA, CCN 501339

Procedures performed for Medicare patients

ProcedureNumber of procedures
Spinal fusion40
Laminectomy or laminotomy (partial removal of spine bones)1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD60489943WAMDNeurological Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Health & Services - Washington CurrentSince Jul 29, 2019 Accepting new patients
Providence Health & Services- Washington CurrentSince Jul 29, 2019 Accepting new patients
University of Washington Medical Center Past Accepting new patients

Locations

1321 Colby Ave
Ofc
Everett, WA 98201
Phone (425) 261-4076

1717 13th St
Ste 402
Everett, WA 98201
Phone (425) 297-6400

1717 13th St
Ste 401
Everett, WA 98201
Phone (425) 261-4910

4112 Harbour Pointe Blvd SW
Ste 100
Mukilteo, WA 98275
Phone (425) 347-6330

Organizations & group practices 3

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.

Hospital & facility affiliations 10

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": "1221436800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616112000000",
    "number": "1083863005",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1959 NE PACIFIC STREET",
            "address_2": "DEPARTMENT OF NEUROLOGICAL SURGERY",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "98195",
            "telephone_number": "206-543-3570"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 LENORA ST",
            "address_2": "501",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981212720",
            "telephone_number": "559-260-0047"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SU",
        "first_name": "DAVID",
        "middle_name": "KEISHO",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-09-15",
        "last_updated": "2021-03-19",
        "certification_date": "2021-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "WA",
            "license": "MD60489943",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dsu1112143@wm.providencedirect.org",
            "affiliation": "N",
            "address_1": "1717 13th St Ste 402",
            "city": "Everett",
            "state": "WA",
            "country_code": "US",
            "postal_code": "982011621",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Seattle, WA

Sources for this page

Verify at the official NPI Registry.