Charles Ibeziako, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

ML70050698 Issued in WA

Practice address

1515 E Columbia St
Othello, WA 99344-1846

Phone

(509) 488-5256

Fax

(509) 488-9939

NPI assigned

Sep 6, 2025

Last updated

Sep 23, 2025By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

Other, 1994

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Columbia Basin Health AssociationGroup PAC ID 4486564309, 44 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Columbia Basin Health Association

  dba Eagle Eye Care

  • Federally Qualified Health Center (FQHC)
  • Connell, WA
  • NPI 1528316379
  Medicare reassignment Care Compare group NPD
• Columbia Basin Health Association

  • Federally Qualified Health Center (FQHC)
  • Pasco, WA
  • NPI 1225716947

  Family Medicine

  NPD
• Columbia Basin Health Association

  dba Connell Pharmacy

  • Pharmacist
  • Connell, WA
  • NPI 1629311436
  NPD

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

{
    "created_epoch": "1757116800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1758585600000",
    "number": "1093695249",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1515 E COLUMBIA ST",
            "city": "OTHELLO",
            "state": "WA",
            "postal_code": "993441846",
            "telephone_number": "509-488-5256",
            "fax_number": "509-488-9939"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1515 E COLUMBIA ST",
            "city": "OTHELLO",
            "state": "WA",
            "postal_code": "993441846",
            "telephone_number": "509-488-5256",
            "fax_number": "509-488-9939"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "601 Government Rd",
            "address_purpose": "LOCATION",
            "city": "Mattawa",
            "state": "WA",
            "postal_code": "993495120",
            "country_code": "US",
            "telephone_number": "509-488-5256",
            "fax_number": "509-488-9939",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "IBEZIAKO",
        "first_name": "CHARLES",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-09-06",
        "last_updated": "2025-09-23",
        "certification_date": "2025-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "ML70050698",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David Hofheins, DO
• Kyle Shane Hogaboam, PHARM D
• Andrew Daniel Horne, ARNP
• Larissa Huitron, LMHC-A
• Patricia Ann Hull, L.P.C.
• Sonia Veronica Idrogo, DMD
• Inland Northwest Renal Care Group, LLC (Fresenius Medical Care Leah Layne Dialysis Clinic)
• Andrew Robert Jacobson, PHARMACIST
• Douglas Ray Jahns, ARNP
• Mishka K James, PA-C

• Family Medicine Physician in Othello, WA
• Providers in Othello, WA by specialty
• Family Medicine Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.