NPIMap

Organization Active NPI

Evergreen Center for Integrative Medicine PLLC

  • Primary Care Clinic/Center
  • Seattle, WA
National Provider Identifier
1194483289
Registry record updated Dec 6, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
EVERGREEN CENTER FOR INTEGRATIVE MEDICINE PLLC
Practice address
2008 NE 65TH St
Seattle, WA 98115-6934
Phone
(206) 729-0907
Fax
(206) 729-0199
NPI assigned
Dec 6, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 6, 2021

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

Authorized official

Name
Amanda Baker
Title
Practice Manager
Phone
(206) 729-0907

Specialties & licenses 1

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

Addresses

Primary practice location

2008 NE 65TH St
Seattle, WA 98115-6934

Mailing address

2008 NE 65TH St
Seattle, WA 98115-6934
Phone (206) 729-0907

Other identifiers 1

IdentifierTypeStateIssuer
1881741288OtherINDIVIDUAL NPI

Other names 1

  • Bobbi Lutack,ND Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address drbobbi@evergreencenter.net Direct

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1638748800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1638748800000",
    "number": "1194483289",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2008 NE 65TH ST",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981156934",
            "telephone_number": "206-729-0907",
            "fax_number": "206-729-0199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2008 NE 65TH ST",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981156934",
            "telephone_number": "206-729-0907",
            "fax_number": "206-729-0199"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN CENTER FOR INTEGRATIVE MEDICINE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-06",
        "last_updated": "2021-12-06",
        "certification_date": "2021-12-06",
        "status": "A",
        "authorized_official_last_name": "BAKER",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "206-729-0907"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI",
            "identifier": "1881741288",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "drbobbi@evergreencenter.net",
            "affiliation": "N",
            "endpointDescription": "work email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "2008 NE 65th St",
            "city": "Seattle",
            "state": "WA",
            "country_code": "US",
            "postal_code": "981156934",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Bobbi Lutack,ND",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Seattle, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2021; 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.