Mark Tom

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

MD61144305 Issued in WA

Practice address

3927 Rucker Ave
Everett, WA 98201-4833

Phone

(425) 339-5422

Fax

(425) 339-5444

NPI assigned

May 31, 2018

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Electronic endpoints 1

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

Specialty

Family Practice

Education

University of Washington School of Medicine, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Providence Health and Services- WashingtonGroup PAC ID 8325100480, 527 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Providence Regional Medical Center Everett Hospital, Everett, WA, CCN 500014

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mtom72474@direct.tecmc.com

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.

• Providence Health & Services- Washington

  • General Practice Physician
  • Everett, WA
  • NPI 1124270715
  Medicare reassignment Care Compare group NPD
• Kaiser Foundation Health Plan of Washington

  • Multi-Specialty Clinic/Center
  • Seattle, WA
  • NPI 1396810701
  Medicare reassignment NPD
• Optum Care Washington PLLC

  • Multi-Specialty Clinic/Center
  • Everett, WA
  • NPI 1831186766

  Family Medicine

  Medicare reassignment NPD
• The Polyclinic PLLC

  • Audiologist
  • Seattle, WA
  • NPI 1174594634

  Family Medicine

  Medicare reassignment NPD
• Kaiser Foundation Health Plan of Washington

  • Multi-Specialty Clinic/Center
  • Everett, WA
  • NPI 1386935351
  NPD
• Optum Care Washington PLLC

  • Durable Medical Equipment & Medical Supplies
  • Marysville, WA
  • NPI 1194428425

  Family Medicine

  NPD
• Providence Health & Services - Washington

  • Family Medicine Physician
  • Monroe, WA
  • NPI 1225289333
  NPD
• The Polyclinic

  • Radiation Oncology Physician
  • Seattle, WA
  • NPI 1962824219
  NPD
• The Polyclinic PLLC

  • Durable Medical Equipment & Medical Supplies
  • Tacoma, WA
  • NPI 1831411487

  Family Medicine

  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Providence Health & Services-Wa

  • Hospitalist Physician
  • Everett, WA
  • NPI 1649615220
  Care Compare affiliation
• Providence Health & Services-Wa

  • General Acute Care Hospital
  • Everett, WA
  • NPI 1700037801
  Care Compare affiliation

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

{
    "created_epoch": "1527724800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682553600000",
    "number": "1144712639",
    "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": "425-304-8431"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3927 RUCKER AVE",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982014833",
            "telephone_number": "425-339-5422",
            "fax_number": "425-339-5444"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1919 Lincoln Way Ste 315",
            "address_purpose": "LOCATION",
            "city": "Coeur D Alene",
            "state": "ID",
            "postal_code": "838142527",
            "country_code": "US",
            "telephone_number": "208-625-6000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "14402 E Sprague Ave",
            "address_purpose": "LOCATION",
            "city": "Spokane Valley",
            "state": "WA",
            "postal_code": "992162167",
            "country_code": "US",
            "telephone_number": "509-922-2625",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TOM",
        "first_name": "MARK",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-05-31",
        "last_updated": "2023-04-27",
        "certification_date": "2023-04-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "MD61144305",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "MD.MD.61144305",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwa.kp.org:14430/Interconnect-CE-PRD/wcf/epic.community.hie/xcpdrespondinggatewaysync",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "14402 E Sprague Ave",
            "city": "Spokane Valley",
            "state": "WA",
            "country_code": "US",
            "postal_code": "992162167",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jessica Marie Tokarchuk, MA, AAC
• Khadijah Toledano
• Barbara Thamir Toledo
• Lindee Lorene Tollefsen, R.N.
• Ryan J Tolman, MSW, LICSW
• Sherdena Denise Toman
• Melissa Anne Toner, MHT3,AAC-R
• Josemary Tavares Tonn
• Suzann S Tonseth, LMP, CNA
• Loretta Ainslie Toole, MA

• Family Medicine Physician in Everett, WA
• Providers in Everett, WA by specialty
• Family Medicine Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.