Active NPI
Samuel Ballesteros Echaure, M.D.
- Surgery Physician
- Tacoma, WA
National Provider Identifier
1164520920
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- A44205
- Practice address
- 9040 Jackson Ave Joint Base Lewis McChord
Tacoma, WA 98431-8273 - Phone
- (253) 968-5480
- NPI assigned
- Sep 20, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | A44205 | CA | Primary |
Addresses
Primary practice location
9040 Jackson Ave Joint Base Lewis McChord
Tacoma, WA 98431-8273
Mailing address
3447 Juno St NE
Lacey, WA 98516-4503
Phone (951) 237-9204
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A44205 | CA | MD | Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158710400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1550620800000",
"number": "1164520920",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3447 JUNO ST NE",
"city": "LACEY",
"state": "WA",
"postal_code": "985164503",
"telephone_number": "951-237-9204"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9040 JACKSON AVE JOINT BASE LEWIS MCCHORD",
"city": "TACOMA",
"state": "WA",
"postal_code": "984318273",
"telephone_number": "253-968-5480"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ECHAURE",
"first_name": "SAMUEL",
"middle_name": "BALLESTEROS",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-09-20",
"last_updated": "2019-02-20",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "CA",
"license": "A44205",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tacoma, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.