Individual provider Active NPI

Randy Wang, DO

  • Family Medicine Physician
  • Seattle, WA
National Provider Identifier
1184918112
Registry record updated May 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
OP60408313 Issued in WA
Practice address
1660 S Columbian Way
BLDG 1 Room 113
Seattle, WA 98108-1532
Phone
(206) 277-5158
NPI assigned
Jun 7, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 9, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X OP60408313 WA Primary

Addresses

Primary practice location

1660 S Columbian Way
BLDG 1 Room 113
Seattle, WA 98108-1532

Mailing address

1660 S Columbian Way
BLDG 1 Room 113
Seattle, WA 98108-1532
Phone (206) 277-5158

Other identifiers 1

IdentifierTypeStateIssuer
1184918112MedicaidWA

Electronic endpoints 3

TypeEndpointUseAffiliation
Direct Messaging Address rwang1364998@wm.providencedirect.org
Direct Messaging Address rwang1364998@wm.providencedirect.org
Direct Messaging Address medicalrecords.healthpoint.p3@direct.hpc.nextgenshare.com

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
I20141125001136 WA Practitioner - Family Practice 3779706890 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
OP60408313WAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Neighborcare Health CurrentSince Aug 25, 2014 Accepting new patients
Neighborcare Health CurrentSince Aug 25, 2014 Accepting new patients
Neighborcare Health Current Accepting new patients
Neighborcare Health Current Accepting new patients

Locations

9245 Rainier Ave S
Seattle, WA 98118
Phone (206) 461-6981

12721 30th Ave NE
Ste 101
Seattle, WA 98125
Phone (206) 417-0326

6020 35th Ave SW
Seattle, WA 98126
Phone (206) 461-6950

1930 Post Aly
Seattle, WA 98101
Phone (206) 728-4143

1200 12th Ave S
Ste 901
Seattle, WA 98144
Phone (206) 548-3058

4400 37th Ave S
Seattle, WA 98118
Phone (206) 296-4650

1629 N 45th St
Seattle, WA 98103
Phone (206) 633-3350

Interoperability endpoints

  • Direct secure messaging: rwang1364998@wm.providencedirect.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": "1307404800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1683590400000",
    "number": "1184918112",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1660 S COLUMBIAN WAY",
            "address_2": "BLDG 1 ROOM 113",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981081532",
            "telephone_number": "206-277-5158"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1660 S COLUMBIAN WAY",
            "address_2": "BLDG 1 ROOM 113",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981081532",
            "telephone_number": "206-277-5158"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WANG",
        "first_name": "RANDY",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-06-07",
        "last_updated": "2023-05-09",
        "certification_date": "2023-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "OP60408313",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1184918112",
            "state": "WA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rwang1364998@wm.providencedirect.org",
            "affiliation": "N",
            "address_1": "217 Broadway E",
            "city": "Seattle",
            "state": "WA",
            "country_code": "US",
            "postal_code": "981025723",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rwang1364998@wm.providencedirect.org",
            "affiliation": "N",
            "address_1": "37624 SE Fury St Ste 101",
            "city": "Snoqualmie",
            "state": "WA",
            "country_code": "US",
            "postal_code": "980659680",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "medicalrecords.healthpoint.p3@direct.hpc.nextgenshare.com",
            "affiliation": "N",
            "address_1": "26401 Pacific Hwy S Ste 101",
            "city": "Des Moines",
            "state": "WA",
            "country_code": "US",
            "postal_code": "981989247",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Seattle, WA

Sources for this page

Verify at the official NPI Registry.