NPIMap

Organization Active NPI

King County Public Hospital District No. 2

Doing business as EvergreenHealth Medical Center

  • Rehabilitation Hospital Unit
  • Kirkland, WA
National Provider Identifier
1154411338
Registry record updated Nov 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation Hospital UnitTaxonomy code 273Y00000X
Legal business name
KING COUNTY PUBLIC HOSPITAL DISTRICT NO. 2
Doing business as
EvergreenHealth Medical Center
Practice address
12040 NE 128TH St
Kirkland, WA 98034-3013
Phone
(425) 899-1000
NPI assigned
Oct 16, 2006
Last updated
Nov 6, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
KING COUNTY PUBLIC HOSPITAL DISTRICT NO. 2As reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 6, 2024

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

Authorized official

Name
William Howe
Title
Cfo
Phone
(425) 899-2606

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation Hospital Unit 273Y00000X Primary

Addresses

Primary practice location

12040 NE 128TH St
Kirkland, WA 98034-3013

Mailing address

PO Box 102928
Pasadena, CA 91189-2928
Phone (425) 899-3868

Other names 1

  • EvergreenHealth Medical Center Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031111000557 WA Part B Supplier - Clinic/Group Practice 7618880097 Receives reassigned benefits from 1,160 practitioners
27 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Kirkland, WA; Mill Creek, WA; Monroe, WA; Redmond, WA; Sammamish, WA; Sultan, WA; Woodinville, WA; Bothell, WA…
O20080212000662 WA Part A Provider - Hospital 7618880097 Practice locations: Kirkland, WA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1154411338. Details of each certification follow.

Hospital certification: CCN 50T124

Legal name
KING COUNTY PUBLIC HOSPITAL DISTRICT NO 2
Doing business as
EVERGREENHEALTH MEDICAL CENTER
Organization structure
OtherNon-profit
Incorporated
Mar 9, 1972 in WA
Enrollment address
12040 NE 128TH St
Kirkland, WA 89034-3013
Hospital Rehabilitation Unit
Hospital subgroups
Rehabilitation unit

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 4

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

Other NPIs on the same Medicare enrollment 27

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

View all 27

Care Compare: Inpatient rehabilitation facility

Medicare Care Compare
Listed as
Evergreen HealthcareCCN 50T124 · All quality measures
Ownership
Government
Certified
Jan 1, 2003

National Provider Directory

National Provider Directory
Part of
Ehmc Bothell Sr HLTH CT

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
William Howe Individual Corporate OfficerChief Financial Officer Jul 22, 2024
Operational/Managerial ControlChief Financial Officer Jul 22, 2024
King County Public Hospital District No 2 Organization, Kirkland, WA 5% Or Greater Direct Ownership Interest Mar 9, 1972 100%
Ettore G Palazzo Individual Corporate OfficerCeo Dec 10, 2023
Operational/Managerial ControlCeo Dec 10, 2023

Owners & managing parties with NPI records 4

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 4

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

FacilityTypeRoleSince
Evergreenhealth Medical CenterKirkland, WA, CCN 500124 Hospital 5% Or Greater Direct Ownership Interest (100%) Mar 9, 1972
Evergreen Health MonroeMonroe, WA, CCN 500084 Hospital Operational/Managerial Control (100%) Mar 1, 2015
Evergreenhealth Home CareKirkland, WA, CCN 507079 Home health agency Operational/Managerial Control (100%) Jan 2, 1968
Evergreenhealth Hospice CareKirkland, WA, CCN 501523 Hospice 5% Or Greater Direct Ownership Interest (100%) Mar 9, 1972

Owned or controlled facilities with NPI records 5

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

Facilities with the same owner 4

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 2

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.

Affiliated clinicians 2

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1160956800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730851200000",
    "number": "1154411338",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 102928",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911892928",
            "telephone_number": "425-899-3868",
            "fax_number": "425-899-3269"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12040 NE 128TH ST",
            "city": "KIRKLAND",
            "state": "WA",
            "postal_code": "980343013",
            "telephone_number": "425-899-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KING COUNTY PUBLIC HOSPITAL DISTRICT NO. 2",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KING COUNTY PUBLIC HOSPITAL DISTRICT NO. 2",
        "enumeration_date": "2006-10-16",
        "last_updated": "2024-11-06",
        "certification_date": "2024-11-06",
        "status": "A",
        "authorized_official_last_name": "HOWE",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "425-899-2606"
    },
    "taxonomies": [
        {
            "code": "273Y00000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Unit",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "EvergreenHealth Medical Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "EvergreenHealth Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kirkland, WA

Sources for this page

Verify at the official NPI Registry.