Individual provider Active NPI

Roberto Emilio Montenegro, MD

  • Psychiatry Physician
  • Seattle, WA
National Provider Identifier
1164765970
Registry record updated May 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
MD60632843 Issued in WA
Practice address
4730 University Way NE Ste 104
#2245
Seattle, WA 98105-4424
Phone
(425) 954-3127
NPI assigned
Mar 29, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 7, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X A173032 CA
Psychiatry Physician 2084P0800X MD60632843 WA Primary

Addresses

Primary practice location

4730 University Way NE Ste 104
#2245
Seattle, WA 98105-4424

Mailing address

4730 University Way NE Ste 104
#2245
Seattle, WA 98105-4424
Phone (425) 954-3127

Other practice location 1

10626 1/2 Eastborne Ave
Los Angeles, CA 90024-5980
Phone (425) 954-3127

Other identifiers 1

IdentifierTypeStateIssuer
1164765970MedicaidWA

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
I20180820002984 WA Practitioner - Psychiatry 6608187927 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A173032CAMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Montenegro & Associates Behavioral Health Psychiatry Current Accepting new patients
The Association of University Physicians Psychiatry CurrentSince Jul 18, 2018 Accepting new patients
Association of CHMC and University Physicians CurrentSince Aug 13, 2018 Accepting new patients
The Association of Chrmc and University Physicians Psychiatry CurrentSince Aug 13, 2018 Accepting new patients

Locations

900 Pacific Ave
Ste 100
Everett, WA 98201
Phone (425) 304-6080

4800 Sand Point Way NE
Seattle, WA 98105
Phone (206) 526-2000

1959 NE Pacific St
Seattle, WA 98195
Phone (206) 598-4333

4730 University Way NE
Ste 104
Seattle, WA 98105
Phone (206) 627-0995

Interoperability endpoints

  • Direct secure messaging: rmontenegro23725@direct.seattlechildrens.org
  • Direct secure messaging: rmontenegro447592@direct.ehre.uwmedicine.org

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.

NPI Registry JSON

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

{
    "created_epoch": "1364515200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1746576000000",
    "number": "1164765970",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4730 UNIVERSITY WAY NE STE 104",
            "address_2": "#2245",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981054424",
            "telephone_number": "425-954-3127"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4730 UNIVERSITY WAY NE STE 104",
            "address_2": "#2245",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981054424",
            "telephone_number": "425-954-3127"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10626 1/2 Eastborne Ave",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "900245980",
            "country_code": "US",
            "telephone_number": "425-954-3127",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MONTENEGRO",
        "first_name": "ROBERTO",
        "middle_name": "EMILIO",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-03-29",
        "last_updated": "2025-05-07",
        "certification_date": "2025-05-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "A173032",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "WA",
            "license": "MD60632843",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1164765970",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Seattle, WA

Sources for this page

Verify at the official NPI Registry.