NPIMap

Individual provider Active NPI

Charles Vladimir Kotal, M.D.

  • Internal Medicine Physician
  • Anacortes, WA
National Provider Identifier
1104888361
Registry record updated May 8, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD00035345 Issued in WA
Practice address
912 32ND St.
Ste a
Anacortes, WA 98221
Phone
(360) 416-5750
Fax
(360) 416-5758
NPI assigned
Apr 4, 2006
Last updated
May 8, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 8, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD00035345 WA Primary
Hospitalist Physician 208M00000X MD00035345 WA

Addresses

Primary practice location

912 32ND St.
Ste a
Anacortes, WA 98221

Mailing address

PO Box 5127
Everett, WA 98206-5127
Phone (360) 293-4343

Other practice location 1

528 Myrtle St
La Conner, WA 98257
Phone (360) 466-3136

Other identifiers 2

IdentifierTypeStateIssuer
GAB33047OtherGROUP
8229627MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050328000306 WA Practitioner - Internal Medicine 8820044431 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Virginia Commonwealth University, School of Medicine, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Northwest Hospital Medicine Physicians LLCGroup PAC ID 6406805449, 67 clinicians
Select Outpatient Services IncGroup PAC ID 4082868815, 750 clinicians
Select Rehabilitation, LLCGroup PAC ID 9032020490, 1,935 clinicians

Practice addresses (Care Compare)

1211 24TH St
Anacortes, WA 98221-2562
Phone (360) 299-1350

2600 Compass Rd
Glenview, IL 60026-8001

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Public Hospital District No 2 Skagit County Washington CurrentSince May 19, 2008 Accepting new patients
Public Hospital District No 2 Skagit County Washington CurrentSince May 19, 2008 Accepting new patients
Public Hospital District No 2 Skagit County Washington Current Accepting new patients
Northwest Hospital Medicine Physicians LLC Internal Medicine CurrentSince May 1, 2024 Accepting new patients
Public Hospital District No 2 Skagit County Washington Past Accepting new patients
Public Hospital District No 2 Skagit County Washington Past Accepting new patients

Locations

1211 24th St
Anacortes, WA 98221
Phone (360) 293-3181

Interoperability endpoints

  • Direct secure messaging: ckotal@islandinternalmedicine.direct.min-ns.md

Organizations & group practices 7

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.

Hospital & facility affiliations 13

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1144108800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1588896000000",
    "number": "1104888361",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5127",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982065127",
            "telephone_number": "360-293-4343",
            "fax_number": "360-588-1587"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "912 32ND ST.",
            "address_2": "STE A",
            "city": "ANACORTES",
            "state": "WA",
            "postal_code": "98221",
            "telephone_number": "360-416-5750",
            "fax_number": "360-416-5758"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "528 Myrtle St",
            "address_purpose": "LOCATION",
            "city": "LA CONNER",
            "state": "WA",
            "postal_code": "98257",
            "country_code": "US",
            "telephone_number": "360-466-3136",
            "fax_number": "360-466-0107",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KOTAL",
        "first_name": "CHARLES",
        "middle_name": "VLADIMIR",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-04",
        "last_updated": "2020-05-08",
        "certification_date": "2020-05-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WA",
            "license": "MD00035345",
            "primary": true
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "WA",
            "license": "MD00035345",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP",
            "identifier": "GAB33047",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8229627",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Anacortes, WA

Sources for this page

Verify at the official NPI Registry.