Active NPI
Gail Fahey, M.D.
- Case Management Agency
- Vancouver, WA
National Provider Identifier
1174915151
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Case Management Agency
- License
- 4028798
- Practice address
- 1601 E Fourth Plain Blvd
Vancouver, WA 98661-3713 - Phone
- (360) 696-4061
- NPI assigned
- Feb 27, 2015
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Cognitive & Behavioral Psychologist | 103TB0200X | 33780981 | WA | |
| Foster Care Agency | 253J00000X | 4054878 | WA | |
| Case Management Agency | 251B00000X | 4028798 | WA | Primary |
| Respite Care | 385H00000X | 60167155 | WA |
Addresses
Primary practice location
1601 E Fourth Plain Blvd
Vancouver, WA 98661-3713
Mailing address
1601 E Fourth Plain Blvd
Vancouver, WA 98661-3713
Phone (360) 696-4061
Other identifiers 15
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 680-709 | Other | WA | ICD-9CM |
| CIMC | Other | WA | INTERNAL MEDICINE |
| P100, P300 | Other | WA | STRUCTURE, STRATEGY, ANALYSIS |
| 390-459 | Other | WA | ICD-9CM |
| C100, C200, C300 | Other | WA | COUNSELING |
| C400 | Other | WA | COUNSELING |
| CEMC | Other | WA | EVALUATION AND MANAGEMENT |
| CFPC | Other | WA | FAMILY PRACTICE |
| T1015 | Other | WA | CLINIC SERVICE |
| 740-759 | Other | WA | ICD-9CM |
| CHONC | Other | WA | HEMATOLOGY AND ONCOLOGY |
| L100, L300, A100 | Other | WA | CASE ASSESSMENT, DEVELOPMENT, AND ADMINISTRATION |
| 1174915151 | Other | WA | PATHOLOGY |
| 140-239 | Other | WA | ICD-9-CM |
| CEDC | Other | WA | EMERGENCY DEPARTMENT |
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 |
|---|---|---|---|
| 33780981 | WA | MD | Cognitive & Behavioral Psychologist |
| 4028798 | WA | MD | Case Management Agency |
| 4054878 | WA | MD | Foster Care Agency |
| 60167155 | WA | MD | Respite Care |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1424995200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1484352000000",
"number": "1174915151",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1601 E FOURTH PLAIN BLVD",
"city": "VANCOUVER",
"state": "WA",
"postal_code": "986613713",
"telephone_number": "360-696-4061"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1601 E FOURTH PLAIN BLVD",
"city": "VANCOUVER",
"state": "WA",
"postal_code": "986613713",
"telephone_number": "360-696-4061"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAHEY",
"first_name": "GAIL",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-02-27",
"last_updated": "2017-01-14",
"status": "A"
},
"taxonomies": [
{
"code": "103TB0200X",
"taxonomy_group": "",
"desc": "Psychologist, Cognitive & Behavioral",
"state": "WA",
"license": "33780981",
"primary": false
},
{
"code": "253J00000X",
"taxonomy_group": "",
"desc": "Foster Care Agency",
"state": "WA",
"license": "4054878",
"primary": false
},
{
"code": "251B00000X",
"taxonomy_group": "",
"desc": "Case Management",
"state": "WA",
"license": "4028798",
"primary": true
},
{
"code": "385H00000X",
"taxonomy_group": "",
"desc": "Respite Care",
"state": "WA",
"license": "60167155",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ICD-9CM",
"identifier": "680-709",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "INTERNAL MEDICINE",
"identifier": "CIMC",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STRUCTURE, STRATEGY, ANALYSIS",
"identifier": "P100, P300",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ICD-9CM",
"identifier": "390-459",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "COUNSELING",
"identifier": "C100, C200, C300",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "COUNSELING",
"identifier": "C400",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "EVALUATION AND MANAGEMENT",
"identifier": "CEMC",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FAMILY PRACTICE",
"identifier": "CFPC",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CLINIC SERVICE",
"identifier": "T1015",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ICD-9CM",
"identifier": "740-759",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEMATOLOGY AND ONCOLOGY",
"identifier": "CHONC",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CASE ASSESSMENT, DEVELOPMENT, AND ADMINISTRATION",
"identifier": "L100, L300, A100",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PATHOLOGY",
"identifier": "1174915151",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ICD-9-CM",
"identifier": "140-239",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "EMERGENCY DEPARTMENT",
"identifier": "CEDC",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Vancouver, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.