Individual provider Active NPI

Mikyung Chung, CRNA

  • Certified Registered Nurse Anesthetist
  • Seattle, WA
National Provider Identifier
1104147289
Registry record updated May 10, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
AP60821954 Issued in WA
Practice address
1100 9TH Ave
Seattle, WA 98101-2756
Phone
(206) 223-6600
NPI assigned
Jun 12, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 10, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X L6-0A00675 DE
Certified Registered Nurse Anesthetist 367500000X AP60821954 WA Primary

Addresses

Primary practice location

1100 9TH Ave
Seattle, WA 98101-2756

Mailing address

1100 9TH Ave
M4-PFS
Seattle, WA 98101-2756
Phone (206) 515-5811

Other practice location 1

801 Middleford Road
Seaford, DE 19973
Phone (800) 437-2672

Other practice location 2

801 Middleford Road
Seaford, DE 19973
Phone (800) 437-2672

Other identifiers 1

IdentifierTypeStateIssuer
1104147289MedicaidDE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220902000606 CA Practitioner - Certified Registered Nurse Anesthetist (Crna) 0547385981 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St. Helena HospitalGroup PAC ID 8729059878, 85 clinicians
Lyons Huber ManagementGroup PAC ID 4789093741, 6 clinicians

Practice addresses (Care Compare)

10 Woodland Rd
Saint Helena, CA 94574-9554
Phone (707) 963-3611

15630 18TH Ave
Clearlake, CA 95422-9336
Phone (707) 994-6486

Hospital & facility affiliations

  • Adventist Health Clearlake Hospital, Clearlake, CA, CCN 051317
  • Adventist Health St Helena Hospital, Saint Helena, CA, CCN 050013

Merit-based Incentive Payment System (MIPS)

Final score
90.74 of 100Reported as group
Quality
94
Promoting interoperability
92
Improvement activities
40
Cost
65.12

Merit-based Incentive Payment System (MIPS)

Final score
85.91 of 100Reported as group
Quality
75.49
Promoting interoperability
94
Improvement activities
40
Cost
73.96

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
L6-0A00675DEMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
St. Helena Hospital CurrentSince Jul 1, 2022 Accepting new patients
Mai Nursing Anesthesia PC CurrentSince Aug 18, 2024 Accepting new patients
Lyons Huber Management Nurse Anesthetist, Certified Registered CurrentSince Jun 1, 2023 Accepting new patients
St. Helena Hospital CurrentSince Jul 1, 2022 Accepting new patients

Locations

429 Llewellyn Ave
Campbell, CA 95008
Phone (408) 358-5000

15630 18th Ave
Clearlake, CA 95422
Phone (707) 995-5820

3365 Solano Ave
Napa, CA 94558
Phone (707) 266-6878

1700 San Pablo Ave
Ste D
Pinole, CA 94564
Phone (510) 724-9500

6 Woodland Rd
Ste 202
Saint Helena, CA 94574
Phone (707) 963-5294

10 Woodland Rd
Saint Helena, CA 94574
Phone (707) 963-2002

3003 Paul Sweet Rd
Santa Cruz, CA 95065
Phone (831) 462-1607

3540 Mendocino Ave
Ste 200
Santa Rosa, CA 95403
Phone (707) 522-6200

2160 W Grant Line Rd
Ste 120
Tracy, CA 95377
Phone (209) 832-2095

Organizations & group practices 4

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 2

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": "1276300800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1525910400000",
    "number": "1104147289",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 9TH AVE",
            "address_2": "M4-PFS",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981012756",
            "telephone_number": "206-515-5811",
            "fax_number": "206-341-0274"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 9TH AVE",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981012756",
            "telephone_number": "206-223-6600"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "801 Middleford Road",
            "address_purpose": "LOCATION",
            "city": "Seaford",
            "state": "DE",
            "postal_code": "19973",
            "country_code": "US",
            "telephone_number": "800-437-2672",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "801 Middleford Road",
            "address_purpose": "LOCATION",
            "city": "Seaford",
            "state": "DE",
            "postal_code": "19973",
            "country_code": "US",
            "telephone_number": "800-437-2672",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CHUNG",
        "first_name": "MIKYUNG",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-06-12",
        "last_updated": "2018-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "DE",
            "license": "L6-0A00675",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "WA",
            "license": "AP60821954",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1104147289",
            "state": "DE"
        }
    ],
    "endpoints": [],
    "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 May 10, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.