John Michael Hautala, M.D.

Primary specialty

Pediatric Adolescent Medicine PhysicianTaxonomy code 2080A0000X

License

MD00019059 Issued in WA

Practice address

1033 Regents Blvd
Suite 102
Fircrest, WA 98466-6045

Phone

(253) 564-1115

Fax

(253) 565-4552

NPI assigned

Feb 10, 2007

Last updated

Mar 7, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Umbrella Pediatrics PC

  dba Seattle Children's Primary Care Group

  • Pediatrics Physician
  • Mountlake Terrace, WA
  • NPI 1720772387
  NPD (past)
• University Place Pediatric Clinic P S

  • Pediatrics Physician
  • Fircrest, WA
  • NPI 1497922421
  NPD (past)

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

{
    "created_epoch": "1171065600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1174664130",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1033 REGENTS BLVD",
            "address_2": "SUITE 102",
            "city": "FIRCREST",
            "state": "WA",
            "postal_code": "984666045",
            "telephone_number": "253-564-1115",
            "fax_number": "253-565-4552"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1033 REGENTS BLVD",
            "address_2": "SUITE 102",
            "city": "FIRCREST",
            "state": "WA",
            "postal_code": "984666045",
            "telephone_number": "253-564-1115",
            "fax_number": "253-565-4552"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAUTALA",
        "first_name": "JOHN",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-10",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080A0000X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "WA",
            "license": "MD00019059",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1783703",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE NUMBER",
            "identifier": "MD00019059",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "L&I NUMBER",
            "identifier": "108917",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE BLUE SHIELD",
            "identifier": "HA7840",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kimberley Louise Gruening McNickle, LMHC
• Adriana Haberlach, LMP
• Nevin Michael Hair, L.M.P
• Ryan Hannig, BCBA
• Erick Albert Hartman, OD
• Deborah L Hickey, DO
• McKenzie Lynne Hollyoak, DC
• Charles John Hunt, DDS
• David Norris Hunt, DDS
• Integrative Midwifery and Wellcare

• Pediatric Adolescent Medicine Physician in Fircrest, WA
• Providers in Fircrest, WA by specialty
• Pediatric Adolescent Medicine Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.