Individual provider Active NPI

Sara S Chan, PSYD

  • Clinical Psychologist
  • Seattle, WA
National Provider Identifier
1083971063
Registry record updated Dec 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PY61196914 Issued in WA
Practice address
1600 E Jefferson St Ste A1
Seattle, WA 98122-5643
Phone
(206) 320-2200
Fax
(206) 320-2560
NPI assigned
Apr 16, 2012
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 1, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X PY61196914 WA Primary

Addresses

Primary practice location

1600 E Jefferson St Ste A1
Seattle, WA 98122-5643

Mailing address

PO Box 25608
Salt Lake City, UT 84125-0608
Phone (206) 320-4476

Other identifiers 1

IdentifierTypeStateIssuer
2212898MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230104000200 WA Practitioner - Clinical Psychologist 1951771104 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Swedish Health ServicesGroup PAC ID 0244138196, 1,038 clinicians

Practice addresses (Care Compare)

1600 E Jefferson St
Suite A1
Seattle, WA 98122-5643
Phone (206) 320-2200

Merit-based Incentive Payment System (MIPS)

Final score
87.1 of 100Reported as group
Quality
84.53
Promoting interoperability
100
Improvement activities
40
Cost
72.46

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Swedish Health Services CurrentSince Dec 5, 2022 Accepting new patients

Locations

7320 216th St SW
Ste 310
Edmonds, WA 98026
Phone (425) 673-3800

747 Broadway
Seattle, WA 98122
Phone (360) 658-2488

1600 E Jefferson St
Ste A1
Seattle, WA 98122
Phone (206) 320-2200

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1334534400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701388800000",
    "number": "1083971063",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 25608",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841250608",
            "telephone_number": "206-320-4476",
            "fax_number": "206-568-7043"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 E JEFFERSON ST STE A1",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981225643",
            "telephone_number": "206-320-2200",
            "fax_number": "206-320-2560"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHAN",
        "first_name": "SARA",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "PSYD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-04-16",
        "last_updated": "2023-12-01",
        "certification_date": "2021-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "WA",
            "license": "PY61196914",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2212898",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Seattle, WA

Sources for this page

Verify at the official NPI Registry.