NPIMap

Organization Active NPI

BHC Fairfax Hospital Inc.

Doing business as Fairfax Physician Group

  • Psychiatry Physician
  • Kirkland, WA
National Provider Identifier
1104959097
Registry record updated Dec 12, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
BHC FAIRFAX HOSPITAL INC.
Doing business as
Fairfax Physician Group
Practice address
10200 NE 132ND St
Kirkland, WA 98034-2831
Phone
(425) 821-2000
NPI assigned
Mar 13, 2007
Last updated
Dec 12, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 12, 2011

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

Authorized official

Name
Peggy Trachte
Title
Business Office Director
Phone
(425) 284-1708

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084P0800X Primary

Addresses

Primary practice location

10200 NE 132ND St
Kirkland, WA 98034-2831

Mailing address

10200 NE 132ND St
Kirkland, WA 98034-2831
Phone (425) 821-2000

Other identifiers 2

IdentifierTypeStateIssuer
7104326MedicaidWA
7159908MedicaidWA

Other names 1

  • Fairfax Physician Group Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031120000445 WA Part B Supplier - Clinic/Group Practice 1153231857 Receives reassigned benefits from 59 practitioners
Practice locations: Bellevue, WA; Everett, WA; Kirkland, WA; Monroe, WA

Other NPIs with the same Medicare PAC ID 1

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

National Provider Directory

National Provider Directory

Locations

1300 114th Ave SE
Ste 100
Bellevue, WA 98004
Phone (206) 248-4787

14701 179th Ave SE
Monroe, WA 98272
Phone (360) 794-1409

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Inland Northwest Behavioral HealthSpokane, WA, CCN 504014 Hospital 5% Or Greater Direct Ownership Interest (80%) Sep 21, 2016

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 61

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 61

NPI Registry JSON

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

{
    "created_epoch": "1173744000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1323648000000",
    "number": "1104959097",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10200 NE 132ND ST",
            "city": "KIRKLAND",
            "state": "WA",
            "postal_code": "980342831",
            "telephone_number": "425-821-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10200 NE 132ND ST",
            "city": "KIRKLAND",
            "state": "WA",
            "postal_code": "980342831",
            "telephone_number": "425-821-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BHC FAIRFAX HOSPITAL INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-13",
        "last_updated": "2011-12-12",
        "status": "A",
        "authorized_official_last_name": "TRACHTE",
        "authorized_official_first_name": "PEGGY",
        "authorized_official_title_or_position": "BUSINESS OFFICE DIRECTOR",
        "authorized_official_telephone_number": "425-284-1708"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7104326",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7159908",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fairfax Physician Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kirkland, WA

Sources for this page

Verify at the official NPI Registry.