Individual provider Active NPI

Emma Ludesi Makoba

  • Student in an Organized Health Care Education/Training Program
  • Seattle, WA
National Provider Identifier
1164041323
Registry record updated Jun 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
747 Broadway
Seattle, WA 98122-4379
Phone
(206) 320-2000
Fax
(206) 320-4780
NPI assigned
Apr 8, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X Primary

Addresses

Primary practice location

747 Broadway
Seattle, WA 98122-4379

Mailing address

747 Broadway
Seattle, WA 98122-4379
Phone (206) 320-2000

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: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240226002832 WA Practitioner - Family Practice 4789002395 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Icahn School of Medicine at Mount Sinai, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Seattle Roots Community HealthGroup PAC ID 8628966173, 50 clinicians

Practice addresses (Care Compare)

500 19TH Ave E
Seattle, WA 98112-4007
Phone (208) 299-1600

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Seattle Roots Community Health CurrentSince Jan 13, 2024 Accepting new patients
Seattle Roots Community Health CurrentSince Jan 13, 2024 Accepting new patients
Seattle Roots Community Health Current Accepting new patients
Seattle Roots Community Health Past Accepting new patients
Seattle Roots Community Health Past Accepting new patients

Locations

2101 E Yesler Way
Ste 100
Seattle, WA 98122
Phone (206) 987-7200

2101 E Yesler Way
#210
Seattle, WA 98122
Phone (206) 299-1937

500 19th Ave E
Seattle, WA 98112
Phone (206) 299-1600

2101 E Yesler Way
Ste 150
Seattle, WA 98122
Phone (206) 299-1900

2410 E Cherry St
Seattle, WA 98122
Phone (206) 299-1900

301 21st Ave E
Seattle, WA 98112
Phone (206) 709-7190

Interoperability endpoints

  • Direct secure messaging: emma.makoba.p1@direct.crc-fwhc.nextgenshare.com
  • Direct secure messaging: emakoba307988@direct.ochin.org

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1586304000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655942400000",
    "number": "1164041323",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "747 BROADWAY",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981224379",
            "telephone_number": "206-320-2000",
            "fax_number": "206-320-4780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "747 BROADWAY",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981224379",
            "telephone_number": "206-320-2000",
            "fax_number": "206-320-4780"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAKOBA",
        "first_name": "EMMA",
        "middle_name": "LUDESI",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-04-08",
        "last_updated": "2022-06-23",
        "certification_date": "2022-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "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.