Individual provider Active NPI

Petar Jamborcic, MD

  • Internal Medicine Physician
  • Toppenish, WA
National Provider Identifier
1114990538
Registry record updated Jul 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD60593879 Issued in WA
Practice address
510 W 1St Ave
Toppenish, WA 98948-1564
Phone
(509) 865-5600
NPI assigned
Feb 8, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2023

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 11074 NV
Internal Medicine Physician 207R00000X MD60593879 WA Primary

Addresses

Primary practice location

510 W 1St Ave
Toppenish, WA 98948-1564

Mailing address

PO Box 5127
Everett, WA 98206-5127
Phone (425) 258-3900

Other practice location 1

4420 76th St NE
Marysville, WA 98270-3726
Phone (360) 651-7491

Other identifiers 2

IdentifierTypeStateIssuer
100503746MedicaidNV
2050301MedicaidWA

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address pjamborcic41491@yvfwc.direct-ci.com Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160428000849 WA Practitioner - Internal Medicine 4183697030 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD60593879WAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Yakima Valley Memorial Physicians Current Accepting new patients
Yakima Valley Memorial Physicians CurrentSince Jan 28, 2025 Accepting new patients
Yakima Valley Memorial Physicians CurrentSince Jan 28, 2025 Accepting new patients

Locations

3801 Kern Rd
Yakima, WA 98902
Phone (509) 574-3200

4003 Creekside Loop
Yakima, WA 98908
Phone (509) 248-3263

2811 Tieton Dr
Yakima, WA 98902
Phone (509) 249-5210

Interoperability endpoints

  • Direct secure messaging: pjamborcic41491@yvfwc.direct-ci.com
  • Direct secure messaging: pjamborcic821908@direct.multicare.org

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1139356800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689206400000",
    "number": "1114990538",
    "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": "425-258-3900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "510 W 1ST AVE",
            "city": "TOPPENISH",
            "state": "WA",
            "postal_code": "989481564",
            "telephone_number": "509-865-5600"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4420 76th St NE",
            "address_purpose": "LOCATION",
            "city": "Marysville",
            "state": "WA",
            "postal_code": "982703726",
            "country_code": "US",
            "telephone_number": "360-651-7491",
            "fax_number": "360-651-7481",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JAMBORCIC",
        "first_name": "PETAR",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-08",
        "last_updated": "2023-07-13",
        "certification_date": "2023-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NV",
            "license": "11074",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WA",
            "license": "MD60593879",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100503746",
            "state": "NV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2050301",
            "state": "WA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "pjamborcic41491@yvfwc.direct-ci.com",
            "affiliation": "N",
            "endpointDescription": "YVFWC Direct Email Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "510 W 1st Ave",
            "city": "Toppenish",
            "state": "WA",
            "country_code": "US",
            "postal_code": "989481564",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Toppenish, WA

Sources for this page

Verify at the official NPI Registry.