Individual provider Active NPI

Nathan Walter Petakoff, MD

  • Hospitalist Physician
  • Spokane, WA
National Provider Identifier
1154884138
Registry record updated Feb 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospitalist PhysicianTaxonomy code 208M00000X
License
MD61269644 Issued in WA
Practice address
800 W 5TH Ave
Spokane, WA 99204-2803
Phone
(098) 382-5315
Fax
(509) 755-6580
NPI assigned
Apr 8, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 17, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Hospitalist Physician 208M00000X MD61269644 WA Primary

Addresses

Primary practice location

800 W 5TH Ave
Spokane, WA 99204-2803

Mailing address

PO Box 5299
Ms: 820-5-Pco
Tacoma, WA 98415-0299
Phone (253) 459-8009

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: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220917000371 WA Practitioner - Hospitalist 7517342181 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Hospitalist
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Multicare Health SystemGroup PAC ID 7719899897, 2,312 clinicians

Practice addresses (Care Compare)

311 S L St
Tacoma, WA 98405-3720

4700 Point Fosdick Dr
Gig Harbor, WA 98335-1706

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD61269644WAMDHospitalist Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Multicare Health System CurrentSince Aug 3, 2022 Accepting new patients
Multicare Health System Current Accepting new patients
Multicare Health System CurrentSince Aug 3, 2022 Accepting new patients
Multicare Health System Past Accepting new patients

Locations

4700 Point Fosdick Dr
Ste 104
Gig Harbor, WA 98335
Phone (253) 459-7590

800 W 5th Ave
Spokane, WA 99204
Phone (509) 458-5800

311 S L St
Tacoma, WA 98405
Phone (253) 403-1444

Organizations & group practices 4

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.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1554681600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1676592000000",
    "number": "1154884138",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5299",
            "address_2": "MS: 820-5-PCO",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984150299",
            "telephone_number": "253-459-8009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 W 5TH AVE",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992042803",
            "telephone_number": "098-382-5315",
            "fax_number": "509-755-6580"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETAKOFF",
        "first_name": "NATHAN",
        "middle_name": "WALTER",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-04-08",
        "last_updated": "2023-02-17",
        "certification_date": "2023-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "WA",
            "license": "MD61269644",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Spokane, WA

Sources for this page

Verify at the official NPI Registry.