NPIMap

Organization Active NPI

Public Hospital District No. 2

  • Clinical Neuropsychologist
  • Kirkland, WA
National Provider Identifier
1184796799
Registry record updated Apr 2, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical NeuropsychologistTaxonomy code 103G00000X
Legal business name
PUBLIC HOSPITAL DISTRICT NO. 2
Doing business as
Evergreen Healthcare
Practice address
12040 NE 128TH St
Kirkland, WA 98034-3013
Phone
(425) 899-1000
NPI assigned
Nov 15, 2006
Organization subpart
Yes
Parent organization
PUBLIC HOSPITAL DISTRICT NO. 2As reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 2, 2008

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

Authorized official

Name
Chrissy Yamada
Title
Chief Financial Officer
Phone
(425) 899-2600

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical NeuropsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103G00000X Primary

Addresses

Primary practice location

12040 NE 128TH St
Kirkland, WA 98034-3013

Mailing address

PO Box 11610
Tacoma, WA 98411-6610
Phone (425) 899-1000

Other names 1

  • Evergreen Healthcare Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031111000557 WA Part B Supplier - Clinic/Group Practice 7618880097 Receives reassigned benefits from 1,160 practitioners
27 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Kirkland, WA; Mill Creek, WA; Monroe, WA; Redmond, WA; Sammamish, WA; Sultan, WA; Woodinville, WA; Bothell, WA…

Other NPIs on the same Medicare enrollment 27

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 27

National Provider Directory

National Provider Directory
Part of
Ehmc Bothell Sr HLTH CT

NPI Registry JSON

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

{
    "created_epoch": "1163548800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1207094400000",
    "number": "1184796799",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 11610",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984116610",
            "telephone_number": "425-899-1000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12040 NE 128TH ST",
            "city": "KIRKLAND",
            "state": "WA",
            "postal_code": "980343013",
            "telephone_number": "425-899-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PUBLIC HOSPITAL DISTRICT NO. 2",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PUBLIC HOSPITAL DISTRICT NO. 2",
        "enumeration_date": "2006-11-15",
        "last_updated": "2008-04-02",
        "status": "A",
        "authorized_official_last_name": "YAMADA",
        "authorized_official_first_name": "CHRISSY",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "425-899-2600"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Clinical Neuropsychologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Evergreen Healthcare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 2, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.