NPIMap

Organization Active NPI

Evergreenhealth

  • Primary Care Clinic/Center
  • Kirkland, WA
National Provider Identifier
1164876322
Registry record updated Apr 14, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
PH60004517 Issued in WA
Legal business name
EVERGREENHEALTH
Practice address
11521 NE 128TH St
Suite 100
Kirkland, WA 98034-4317
Phone
(425) 899-6797
Fax
(425) 899-6808
NPI assigned
Apr 14, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 14, 2016

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

Authorized official

Name
Connie Smith, MD
Title
Medical Director
Phone
(425) 899-6800

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X PH60004517 WA Primary

Addresses

Primary practice location

11521 NE 128TH St
Suite 100
Kirkland, WA 98034-4317

Mailing address

11521 NE 128TH St
Suite 100
Kirkland, WA 98034-4317
Phone (425) 899-6797

National Provider Directory

National Provider Directory
Tax ID family
Ehmc Bothell Sr HLTH CT25 organizations share this tax ID, including this one

Other organizations with this tax ID 24

Organizations that report the same tax identification number in the National Provider Directory.

View all 24

Locations

11521 NE 128th St
Ste 100
Kirkland, WA 98034
Phone (425) 899-6800

NPI Registry JSON

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

{
    "created_epoch": "1460592000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1460592000000",
    "number": "1164876322",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11521 NE 128TH ST",
            "address_2": "SUITE 100",
            "city": "KIRKLAND",
            "state": "WA",
            "postal_code": "980344317",
            "telephone_number": "425-899-6797",
            "fax_number": "425-899-6808"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11521 NE 128TH ST",
            "address_2": "SUITE 100",
            "city": "KIRKLAND",
            "state": "WA",
            "postal_code": "980344317",
            "telephone_number": "425-899-6797",
            "fax_number": "425-899-6808"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREENHEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-14",
        "last_updated": "2016-04-14",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "CONNIE",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "425-899-6800",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "WA",
            "license": "PH60004517",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kirkland, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.