NPIMap

Individual provider Active NPI

Kevin C Harris, M.D.

  • Otolaryngology Physician
  • Anacortes, WA
National Provider Identifier
1164496808
Registry record updated Oct 27, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
MD00042133 Issued in WA
Practice address
1019 24TH St Ste B
Anacortes, WA 98221-2586
Phone
(360) 336-2178
Fax
(360) 299-8147
NPI assigned
Feb 16, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 27, 2021

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

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X 66209 MN
Facial Plastic Surgery Physician 207YS0123X MD00042133 WA
Otolaryngic Allergy Physician 207YX0602X MD00042133 WA
Otolaryngology/Facial Plastic Surgery Physician 207YX0905X MD00042133 WA
Plastic and Reconstructive Surgery Physician 2086S0122X MD00042133 WA
Surgical Oncology Physician 2086X0206X MD00042133 WA
Otolaryngology Physician 207Y00000X MD00042133 WA Primary

Addresses

Primary practice location

1019 24TH St Ste B
Anacortes, WA 98221-2586

Mailing address

1400 E Kincaid St
Mount Vernon, WA 98274-4127
Phone (360) 336-2178

Other practice location 1

118 S 12th St
Mount Vernon, WA 98274-4036
Phone (360) 336-2178

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kharris12621@skagit.direct-ci.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100908000372 WA Practitioner - OtolaryngologyPractitioner - Surgical OncologyPractitioner - Plastic and Reconstructive SurgeryPractitioner - Allergy/Immunology 2961526348 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
OtolaryngologyAlso: Allergy/Immunology, Plastic and Reconstructive Surgery, Surgical Oncology
Education
Medical College of Wisconsin, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Public Hospital Dist No 1 SkagitGroup PAC ID 6800793522, 321 clinicians

Practice addresses (Care Compare)

1019 24TH St
Suite B
Anacortes, WA 98221-2586
Phone (360) 588-8985

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of skin lesions1-10
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD00042133WAMDSurgical Oncology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Public Hospital Dist No 1 Skagit CurrentSince Jul 27, 2020 Accepting new patients
Proliance Surgeons Inc P S Current Accepting new patients
Public Hospital Dist No 1 Skagit Current Accepting new patients
Proliance Surgeons Inc P S CurrentSince Jan 1, 2014 Accepting new patients
Proliance Surgeons, Inc., P.S. CurrentSince Jan 1, 2014 Accepting new patients
Public Hospital Dist No 1 Skagit Past Accepting new patients

Locations

1019 24th St
#B
Anacortes, WA 98221
Phone (360) 293-8438

111 S 13th St
Mount Vernon, WA 98274
Phone (360) 336-2178

1401 S Laventure Rd
Mount Vernon, WA 98274
Phone (360) 424-2400

1400 E Kincaid St
Mount Vernon, WA 98274
Phone (360) 428-2586

118 S 12th St
Mount Vernon, WA 98274
Phone (360) 336-2178

805 Madison St
Ste 901
Seattle, WA 98104
Phone (206) 264-8100

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 10

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": "1140048000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635292800000",
    "number": "1164496808",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 E KINCAID ST",
            "city": "MOUNT VERNON",
            "state": "WA",
            "postal_code": "982744127",
            "telephone_number": "360-336-2178",
            "fax_number": "360-336-1674"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1019 24TH ST STE B",
            "city": "ANACORTES",
            "state": "WA",
            "postal_code": "982212586",
            "telephone_number": "360-336-2178",
            "fax_number": "360-299-8147"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "118 S 12th St",
            "address_purpose": "LOCATION",
            "city": "Mount Vernon",
            "state": "WA",
            "postal_code": "982744036",
            "country_code": "US",
            "telephone_number": "360-336-2178",
            "fax_number": "360-336-1995",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HARRIS",
        "first_name": "KEVIN",
        "middle_name": "C",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-16",
        "last_updated": "2021-10-27",
        "certification_date": "2021-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "MN",
            "license": "66209",
            "primary": false
        },
        {
            "code": "207YS0123X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Facial Plastic Surgery",
            "state": "WA",
            "license": "MD00042133",
            "primary": false
        },
        {
            "code": "207YX0602X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Otolaryngic Allergy",
            "state": "WA",
            "license": "MD00042133",
            "primary": false
        },
        {
            "code": "207YX0905X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Otolaryngology/Facial Plastic Surgery",
            "state": "WA",
            "license": "MD00042133",
            "primary": false
        },
        {
            "code": "2086S0122X",
            "taxonomy_group": "",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "WA",
            "license": "MD00042133",
            "primary": false
        },
        {
            "code": "2086X0206X",
            "taxonomy_group": "",
            "desc": "Surgery, Surgical Oncology",
            "state": "WA",
            "license": "MD00042133",
            "primary": false
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "WA",
            "license": "MD00042133",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kharris12621@skagit.direct-ci.com",
            "affiliation": "N",
            "endpointDescription": "Provider Direct Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1019 24th St Ste B",
            "city": "Anacortes",
            "state": "WA",
            "country_code": "US",
            "postal_code": "982212586",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Anacortes, WA

Sources for this page

Verify at the official NPI Registry.