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

Sex

Male

Sole proprietor

No

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.

• Columbia Basin Health Association

  • Federally Qualified Health Center (FQHC)
  • Connell, WA
  • NPI 1528316379

  WA

  Medicare reassignment Care Compare group NPD
• Columbia Basin Health Association

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

  Family Medicine

  Care Compare group NPD
• Columbia Basin Health Association

  • Pharmacist
  • Connell, WA
  • NPI 1629311436
  Care Compare group NPD
• Columbia Basin Health Association

  • Pharmacist
  • Mattawa, WA
  • NPI 1033259064
  Care Compare group
• Columbia Basin Health Association

  • Federally Qualified Health Center (FQHC)
  • Mattawa, WA
  • NPI 1053539890
  Care Compare group
• Columbia Basin Health Association

  • Federally Qualified Health Center (FQHC)
  • Othello, WA
  • NPI 1083832232
  Care Compare group
• Columbia Basin Health Association

  • Pharmacist
  • Pasco, WA
  • NPI 1235027749
  Care Compare group
• Columbia Basin Health Association

  • Pharmacist
  • Othello, WA
  • NPI 1407919186
  Care Compare group
• Columbia Basin Health Association

  • Specialty Pharmacy
  • Othello, WA
  • NPI 1528703485
  Care Compare group
• Columbia Basin Health Association

  • Clinic/Center
  • Connell, WA
  • NPI 1841574241
  Care Compare group

Specialty

Family Practice

Education

Other, 1994

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Columbia Basin Health Association 44 clinicians

Practice addresses (Care Compare)

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.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Sep 23, 2025.

{
    "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
• Andrew Robert Jacobson, PHARMACIST
• Douglas Ray Jahns, ARNP
• Clarissa Jimenez, RDH

• All providers in Othello, WA
• 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.