NPIMap

Organization Active NPI

Neighborcare Health

  • Federally Qualified Health Center (FQHC)
  • Seattle, WA
National Provider Identifier
1144629908
Registry record updated Jan 12, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
NEIGHBORCARE HEALTH
Practice address
13555 Aurora Ave N
Seattle, WA 98133-7511
Phone
(206) 548-7600
Fax
(206) 548-7601
NPI assigned
Aug 18, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 12, 2018

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

Authorized official

Name
Michael Erikson
Title
Ceo
Phone
(206) 461-6935

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

13555 Aurora Ave N
Seattle, WA 98133-7511

Mailing address

1200 12TH Ave S Ste 901
Seattle, WA 98144-2712
Phone (206) 548-3114

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040128000573 WA Part B Supplier - Clinic/Group Practice 0143134205 Receives reassigned benefits from 317 practitioners
15 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Seattle, WA; Vashon, WA
O20150108001697 WA Part A Provider - Federally Qualified Health Center (FQHC) 0143134205 Practice locations: Seattle, WA

Federally qualified health center certification: CCN 501987

Legal name
NEIGHBORCARE HEALTH
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 19, 2014
Last certification
Nov 19, 2014
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Aug 12, 1969 in WA
Enrollment address
13555 Aurora Ave N
Seattle, WA 98133-7511

Other NPIs with the same Medicare PAC ID 21

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

View all 21

Other NPIs on the same Medicare enrollment 15

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

View all 15

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 18

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Jennifer R Bell Individual Corporate DirectorBoard Member Jan 1, 2012
John R. Greenlee Individual Corporate DirectorBoard Member Jan 1, 1987
Holly S Ferraro Individual Corporate DirectorBoard Member Jan 1, 2012
Nancy I Douty Individual Corporate DirectorBoard Member Jan 1, 2005
Richard D Rubin Individual Corporate DirectorBoard Member Jan 1, 1988
Romulus D Lee Individual Corporate DirectorBoard Member Jan 1, 2010
Mark Secord Individual Corporate OfficerCeo Dec 1, 1996
Operational/Managerial ControlCeo Dec 1, 1996
Barbara Shickich Individual Corporate DirectorBoard Member Jan 1, 2012
Fariba Etemadi-Nejad Alamdari Individual Corporate DirectorBoard Member Jan 1, 2009
Anthony Bozzuti Individual Corporate DirectorBoard Member Jan 1, 2009
Andrea Dahl Individual Corporate DirectorBoard Member Jan 1, 2001
Tamiko Miyano Individual Corporate DirectorBoard Member Jan 1, 2010
George E Parker Individual Corporate DirectorBoard Member Jan 1, 2001
Joyce K Lammert Individual Corporate DirectorBoard Member Jan 1, 2006
Charisse Marshall Individual W-2 Managing EmployeeBilling Supervisor Nov 15, 2010
Allison B Rhoades Individual Corporate DirectorBoard Member Jan 1, 2011
Evelyn Picketts Individual Corporate DirectorBoard Member Jan 1, 2012
Janine L Childs Individual Corporate OfficerCfo Jan 16, 2010

All facility ownership & control disclosures 7

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

FacilityTypeRoleSince
Neighborcare HealthSeattle, WA, CCN 501957 Federally qualified health center Operational/Managerial Control (100%) Nov 26, 2013
Neighborcare HealthSeattle, WA, CCN 501956 Federally qualified health center Operational/Managerial Control (100%) Nov 25, 2013
Neighborcare Health at Denny International Middle SchoolSeattle, WA, CCN 501959 Federally qualified health center Operational/Managerial Control (100%) Jan 1, 2015
Neighborcare Health at Dearborn Park International SchoolSeattle, WA, CCN 501966 Federally qualified health center Operational/Managerial Control (100%) Apr 7, 2014
Neighbor Care Health at Vashon Island High SchoolVashon, WA, CCN 941038 Federally qualified health center Operational/Managerial Control (100%) Aug 12, 1969
Neighborcare Health at the MorrisonSeattle, WA, CCN 941045 Federally qualified health center Operational/Managerial Control (100%) Aug 12, 1969
Neighborcare Health at MagnusonSeattle, WA, CCN 941055 Federally qualified health center Operational/Managerial Control (100%) May 31, 2019

Owned or controlled facilities with NPI records 7

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

Practitioners & affiliated clinicians

Practitioners 120

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 120

NPI Registry JSON

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

{
    "created_epoch": "1408320000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1515715200000",
    "number": "1144629908",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 12TH AVE S STE 901",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981442712",
            "telephone_number": "206-548-3114",
            "fax_number": "206-762-6355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13555 AURORA AVE N",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981337511",
            "telephone_number": "206-548-7600",
            "fax_number": "206-548-7601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEIGHBORCARE HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-08-18",
        "last_updated": "2018-01-12",
        "status": "A",
        "authorized_official_last_name": "ERIKSON",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "206-461-6935"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Seattle, WA

Sources for this page

Verify at the official NPI Registry.