NPIMap

Organization Active NPI

Valley Roots Family Care PLLC

  • Family Medicine Physician
  • Mount Vernon, WA
National Provider Identifier
1144693250
Registry record updated Dec 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD00040349 Issued in WA
Legal business name
VALLEY ROOTS FAMILY CARE PLLC
Practice address
617 W. Division St.
Mount Vernon, WA 98273
Phone
(360) 428-1884
Fax
(360) 428-1889
NPI assigned
Nov 11, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 21, 2021

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

Authorized official

Name
Tara Thomas
Title
Office Manager
Phone
(360) 428-1884

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X MD00040349 WA Primary

Addresses

Primary practice location

617 W. Division St.
Mount Vernon, WA 98273

Mailing address

617 W. Division St.
Mount Vernon, WA 98273
Phone (360) 428-1884

Other identifiers 3

IdentifierTypeStateIssuer
0220687OtherWALABOR AND INDUSTRIES
2076241MedicaidWA
8457228MedicaidWA

National Provider Directory

National Provider Directory

Locations

1603 S 3rd St
Mount Vernon, WA 98273
Phone (360) 428-1884

617 W Division St
Mount Vernon, WA 98273
Phone (360) 428-1884

Practitioners & affiliated clinicians

Practitioners 7

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

NPI Registry JSON

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

{
    "created_epoch": "1447200000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1640044800000",
    "number": "1144693250",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "617 W. DIVISION ST.",
            "city": "MOUNT VERNON",
            "state": "WA",
            "postal_code": "98273",
            "telephone_number": "360-428-1884",
            "fax_number": "360-428-1889"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "617 W. DIVISION ST.",
            "city": "MOUNT VERNON",
            "state": "WA",
            "postal_code": "98273",
            "telephone_number": "360-428-1884",
            "fax_number": "360-428-1889"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VALLEY ROOTS FAMILY CARE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-11-11",
        "last_updated": "2021-12-21",
        "certification_date": "2021-12-21",
        "status": "A",
        "authorized_official_last_name": "THOMAS",
        "authorized_official_first_name": "TARA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "360-428-1884"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "MD00040349",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LABOR AND INDUSTRIES",
            "identifier": "0220687",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2076241",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8457228",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mount Vernon, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.