NPIMap

Organization Active NPI

Victor R. Michalak

Doing business as dba Cosmetic Surgery & Dermatology of Issaquah, Inc.

  • Ambulatory Surgical Clinic/Center
  • Issaquah, WA
National Provider Identifier
1104877976
Registry record updated Aug 7, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
50-C0001197 Issued in WA
Legal business name
VICTOR R. MICHALAK
Doing business as
dba Cosmetic Surgery & Dermatology of Issaquah, Inc.
Practice address
295 NE Gilman Blvd
Suite 101
Issaquah, WA 98027
Phone
(425) 391-2500
Fax
(425) 391-6464
NPI assigned
May 15, 2006
Last updated
Aug 7, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 7, 2018

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

Authorized official

Name
Tanya Knott
Title
Practice Administrator
Phone
(425) 391-2500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X 50-C0001197 WA Primary

Addresses

Primary practice location

295 NE Gilman Blvd
Suite 101
Issaquah, WA 98027

Mailing address

295 NE Gilman Blvd
Suite 101
Issaquah, WA 98027-2906
Phone (425) 391-2500

Other names 1

  • dba Cosmetic Surgery & Dermatology of Issaquah, Inc. Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040316000463 WA Part B Supplier - Ambulatory Surgical Center 8022918994 Practice locations: Issaquah, WA

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Cosmetic Surgery Dermatology of IssaquahCCN 50C0001197
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory

Locations

295 NE Gilman Blvd
Ste 101
Issaquah, WA 98027
Phone (425) 391-2500

Practitioners & affiliated clinicians

Practitioners 19

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1147651200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1533600000000",
    "number": "1104877976",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "295 NE GILMAN BLVD",
            "address_2": "SUITE 101",
            "city": "ISSAQUAH",
            "state": "WA",
            "postal_code": "980272906",
            "telephone_number": "425-391-2500",
            "fax_number": "425-391-6464"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "295 NE GILMAN BLVD",
            "address_2": "SUITE 101",
            "city": "ISSAQUAH",
            "state": "WA",
            "postal_code": "98027",
            "telephone_number": "425-391-2500",
            "fax_number": "425-391-6464"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VICTOR R. MICHALAK",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-15",
        "last_updated": "2018-08-07",
        "status": "A",
        "authorized_official_last_name": "KNOTT",
        "authorized_official_first_name": "TANYA",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "425-391-2500"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "WA",
            "license": "50-C0001197",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "dba Cosmetic Surgery & Dermatology of Issaquah, Inc.",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "dba Cosmetic Surgery & Dermatology of Issaquah, Inc.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Issaquah, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 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.