NPIMap

Organization Active NPI

Seattle Roots Community Health

Doing business as Nova Wellness Center

  • Federally Qualified Health Center (FQHC)
  • Seattle, WA
National Provider Identifier
1114540457
Registry record updated Jun 5, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
SEATTLE ROOTS COMMUNITY HEALTH
Doing business as
Nova Wellness Center
Seattle Roots at Nova
Practice address
2410 E Cherry St
Seattle, WA 98122
Phone
(206) 709-7166
Fax
(206) 299-1920
NPI assigned
May 21, 2020
Organization subpart
Yes
Parent organization
SEATTLE ROOTS COMMUNITY HEALTHAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 5, 2025

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

Authorized official

Name
Angie J Treptow
Title
Interim Finance Director
Phone
(253) 299-1937

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

2410 E Cherry St
Seattle, WA 98122

Mailing address

2101 E Yesler Way
Suite 210
Seattle, WA 98122-5959
Phone (206) 709-7112

Other identifiers 1

IdentifierTypeStateIssuer
2174445MedicaidWA

Other names 2

  • Nova Wellness Center Doing business as
  • Seattle Roots at Nova Doing business as

Electronic endpoints 2

TypeEndpointUseAffiliation
Other URL Seattle Health Information Exchange (HIE) Country Doctor Community Clinic
Other URL Seattle Health Information Exchange (HIE) Country Doctor Community Clinic

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040308000484 WA Part B Supplier - Clinic/Group Practice 8628966173 Receives reassigned benefits from 66 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Seattle, WA

Other NPIs on the same Medicare enrollment 6

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Part of
Carolyn Downs Family Me

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1590019200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1749081600000",
    "number": "1114540457",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2101 E YESLER WAY",
            "address_2": "SUITE 210",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981225959",
            "telephone_number": "206-709-7112",
            "fax_number": "206-299-1920"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2410 E CHERRY ST",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "98122",
            "telephone_number": "206-709-7166",
            "fax_number": "206-299-1920"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SEATTLE ROOTS COMMUNITY HEALTH",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SEATTLE ROOTS COMMUNITY HEALTH",
        "enumeration_date": "2020-05-21",
        "last_updated": "2025-06-05",
        "certification_date": "2020-11-25",
        "status": "A",
        "authorized_official_last_name": "TREPTOW",
        "authorized_official_first_name": "ANGIE",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "INTERIM FINANCE DIRECTOR",
        "authorized_official_telephone_number": "253-299-1937"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2174445",
            "state": "WA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Seattle",
            "affiliation": "Y",
            "affiliationName": "Country Doctor Community Clinic",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "useOtherDescription": "Seattle",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "None",
            "address_1": "2410 E Cherry St",
            "city": "Seattle",
            "state": "WA",
            "country_code": "US",
            "postal_code": "981224832",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Seattle",
            "affiliation": "Y",
            "affiliationName": "Country Doctor Community Clinic",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "2101 E Yesler Way Ste 210",
            "city": "Seattle",
            "state": "WA",
            "country_code": "US",
            "postal_code": "981225959",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Nova Wellness Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Seattle Roots at Nova",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Jun 5, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.