Active NPI
Manisha Jay Shah, MD
- Cardiovascular Disease Physician
- Sunnyside, WA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Cardiovascular Disease Physician
- License
- MD61345543
- Practice address
- 1016 Tacoma Ave
Sunnyside, WA 98944-2263 - Phone
- (509) 837-1500
- Fax
- (509) 837-4908
- NPI assigned
- Oct 27, 2006
- 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 10
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Cardiovascular Disease Physician | 207RC0000X | 81548 | MN | |
| Cardiovascular Disease Physician | 207RC0000X | J8767 | TX | |
| Cardiovascular Disease Physician | 207RC0000X | 0101271026 | VA | |
| Cardiovascular Disease Physician | 207RC0000X | 62629 | TN | |
| Cardiovascular Disease Physician | 207RC0000X | CDR.0003889 | CO | |
| Cardiovascular Disease Physician | 207RC0000X | MD61345543 | WA | Primary |
| Cardiovascular Disease Physician | 207RC0000X | MD-56384 | IA | |
| Cardiovascular Disease Physician | 207RC0000X | MD27359 | ME | |
| Cardiovascular Disease Physician | 207RC0000X | 2475-320 | WI | |
| Cardiovascular Disease Physician | 207RC0000X | ME169276 | FL |
Addresses
Primary practice location
1016 Tacoma Ave
Sunnyside, WA 98944-2263
Mailing address
6717 Clear Springs Cir
Garland, TX 75044-2826
Phone (940) 765-8484
Other practice location 1
194 E Main St
Fort Kent, ME 04743-1428
Phone (303) 390-1940
Other practice location 2
1900 Sunrise Dr
Saint Peter, MN 56082-5376
Phone (303) 390-1940
Other practice location 3
502 W 4th Ave
Toppenish, WA 98948-1616
Phone (509) 865-3105
Other practice location 4
18797 Alberta St
Oneida, TN 37841-2127
Phone (303) 390-1940
Other practice location 5
1008 Minnequa Ave
Pueblo, CO 81004-3733
Phone (303) 390-1940
Other practice location 6
1111 11th St
Hawarden, IA 51023-1903
Phone (303) 390-1940
Other practice location 7
301 Riverview Ave Ste 700
Norfolk, VA 23510-1065
Phone (757) 252-9365
Other practice location 8
1650 4th St SE
Rochester, MN 55904-4717
Phone (507) 529-6600
Other practice location 9
333 E 2nd St
Richland Center, WI 53581-1914
Phone (303) 390-1940
Other practice location 10
3537 S I 35 E Ste 220
Denton, TX 76210-6813
Phone (972) 765-8484
Other practice location 11
1311 N Mildred Rd
Cortez, CO 81321-2231
Phone (303) 390-1940
Other practice location 12
800 S Fillmore St
Osceola, IA 50213-1669
Phone (303) 390-1940
Other practice location 13
1755 N Mecklenburg Ave
South Hill, VA 23970-4080
Phone (434) 447-3151
Other practice location 14
1720 Central Ave E Ste A
Hampton, IA 50441-1867
Phone (303) 390-1940
Other practice location 15
939 Caroline St
Port Angeles, WA 98362-3909
Phone (303) 390-1940
Other practice location 16
20 Hartford St
Houlton, ME 04730-1891
Phone (303) 390-1940
Other practice location 17
2100 NW 35th Avenue Rd
Ocala, FL 34475-4630
Phone (352) 280-7400
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2259012 | Medicaid | WA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX, IA, WI, WA, ME, VA, CO, MI, FL, MN, OH, TN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 12
Care Compare profile
Medicare Care Compare- Specialty
- Internal Medicine
- Education
- Other, 1994
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Rural Physicians Group-Pannu PLLC
Practice addresses (Care Compare)
1008 Minnequa Ave
Pueblo, CO 81004-3733
Phone (719) 560-4000
1016 Tacoma Ave
Sunnyside, WA 98944-2263
Phone (509) 837-1500
10435 SE 170TH PL
Summerfield, FL 34491-8998
Phone (352) 255-3615
1111 11TH St
Hawarden, IA 51023-1903
Phone (712) 551-3100
140 Academy St
Presque Isle, ME 04769-3102
146 Academy St
Presque Isle, ME 04769-3102
1755 N Mecklenburg Ave
South Hill, VA 23970-4080
Phone (434) 447-3151
18797 Alberta St
Oneida, TN 37841-2127
Phone (423) 569-8521
1900 Sunrise Dr
Saint Peter, MN 56082-5376
Phone (303) 390-1926
194 E Main St
Fort Kent, ME 04743-1428
Phone (207) 834-3155
197 E Main St Upper Level
Northern Light Ear Nose and Throat Care NMM
Fort Kent, ME 04743-1409
Phone (207) 834-1573
210 9TH St SE
Rochester, MN 55904-6425
Phone (507) 288-3443
2100 NW 35TH Ave Rd
Ocala, FL 34475-4630
Phone (352) 870-7400
333 E 2ND St
Richland Center, WI 53581-1914
Phone (608) 647-6321
401 N 11TH St
Richmond, VA 23219-1914
Phone (804) 828-8737
502 W 4TH Ave
Toppenish, WA 98948-1616
Phone (509) 865-3105
618 Hospital Rd
Tappahannock, VA 22560-5000
Phone (804) 443-3311
620 Skyline Dr
Jackson, TN 38301-3923
Phone (731) 541-5000
668 Hospital Rd
Suite 300
Tappahannock, VA 22560-5000
Phone (804) 443-6245
835 Sweitzer St
Greenville, OH 45331-1007
Phone (937) 548-1141
939 Caroline St
Port Angeles, WA 98362-3909
Phone (360) 417-7000
W180N8085 Town Hall Rd
FL 3
Menomonee Falls, WI 53051-3518
Phone (262) 251-1000
Hospital & facility affiliations
- Northern Light a R Gould Hospital
- Northern Maine Medical Center
- The Heart Hospital Baylor Denton
- Baylor Scott & White the Heart Hospital Plano
- Texas Health Presbyterian Hospital Denton
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ME169276 | FL | MD | Cardiovascular Disease Physician |
| MD-56384 | IA | MD | Cardiovascular Disease Physician |
| 81548 | MN | MD | Cardiovascular Disease Physician |
| 62629 | TN | MD | Cardiovascular Disease Physician |
| 0101271026 | VA | MD | Cardiovascular Disease Physician |
| MD61345543 | WA | MD | Cardiovascular Disease Physician |
Practice roles (60 of 67)
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Aspirus Iron River Hospital & Clinics, Inc. | Current | Accepting new patients | |
| St Nicholas Hospital-Sisters of the Third Order of St Francis | Internal Medicine | Current | Accepting new patients |
| Aspirus Riverview Hospital & Clinics, Inc. | Current | Accepting new patients | |
| Southwest Health System, Inc. | Current | Accepting new patients | |
| Aspirus Keweenaw | Current | Accepting new patients | |
| Froedtert &the Medical College of Wisconsin Community Physicians, Inc. | Current | Accepting new patients | |
| Villages Regional Hospital Physician Services LLC | Cardiovascular Disease | Current | Accepting new patients |
| Aspirus Eagle River Hospital, Inc. | Current | Accepting new patients | |
| Aspirus Iron River Hospital & Clinics, Inc. | Current | Accepting new patients | |
| Hemphill County Hospital District | Current | Accepting new patients | |
| Dewitt Medical District | Family Medicine | Current | Accepting new patients |
| Minuteclinic Telehealth Services of Texas Association | Family Medicine | Current | Accepting new patients |
| The Aroostook Medical Center | Current | Accepting new patients | |
| Sentara Medical Group | Family Medicine | Current | Accepting new patients |
| The Howard Young Medical Center, Inc. | Current | Accepting new patients | |
| Aspirus Ironwood Hospital & Clinics, Inc. | Family Medicine | Current | Accepting new patients |
| Hemphill County Hospital District | Current | Accepting new patients | |
| Aspirus Stanley Hospital & Clinics, Inc. | Family Medicine | Current | Accepting new patients |
| Aspirus Medical Group, Inc. | Current | Accepting new patients | |
| Aspirus Rhinelander & Tomahawk Hospitals & Clinics, Inc. | Current | Accepting new patients | |
| Rural Physicians Group-Pannu PLLC | Family Medicine | Current | Accepting new patients |
| Aspirus Medford Hospital & Clinics, Inc. | Current | Accepting new patients | |
| Aspirus Eagle River Hospital & Clinics, Inc. | Current | Accepting new patients | |
| SHC Medical Center Toppenish | Current | Accepting new patients | |
| Manisha Shah MD PA | Cardiovascular Disease | Current | Accepting new patients |
| Aspirus Stanley Hospital & Clinics, Inc | Current | Accepting new patients | |
| Aspirus Medical Group, Inc. | Cardiovascular Disease | Current | Accepting new patients |
| Aspirus Stevens Point Hospital & Clinics, Inc. | Current | Accepting new patients | |
| Aspirus Medford Hospital & Clinics, Inc. | Family Medicine | Current | Accepting new patients |
| Aspirus Riverview Hospital & Clinics, Inc. | Current | Accepting new patients | |
| Dewitt Medical District | Current | Accepting new patients | |
| Aspirus Riverview Hospital & Clinics, Inc. | Current | Accepting new patients | |
| Froedtert &the Medical College of Wisconsin Community Physicians, Inc. | Internal Medicine | Current | Accepting new patients |
| Rural Physicians Group-Pannu PLLC | Family Medicine | Current | Accepting new patients |
| Aspirus Merrill Hospital & Clinics, Inc. | Current | Accepting new patients | |
| Aspirus Iron River Hospital & Clinics, Inc. | Family Medicine | Current | Accepting new patients |
| The Howard Young Medical Center, Inc. | Current | Accepting new patients | |
| Aspirus Medford Hospital & Clinics, Inc. | Family Medicine | Current | Accepting new patients |
| Aspirus Stanley Hospital & Clinics, Inc. | Current | Accepting new patients | |
| Aspirus Stevens Point Hospital & Clinics, Inc. | Current | Accepting new patients | |
| Sunnyside Community Hospital Association | Current | Accepting new patients | |
| Sunnyside Community Hospital Association | Family Medicine | Current | Accepting new patients |
| The Aroostook Medical Center | Current | Accepting new patients | |
| Texas Heart Hospital of the Southwest LLC | Current | Accepting new patients | |
| Morgan County Georgia Hospital Authority | Current | Accepting new patients | |
| Aspirus Rhinelander & Tomahawk Hospitals & Clinics, Inc. | Current | Accepting new patients | |
| Aspirus Medical Group, Inc. | Current | Accepting new patients | |
| Canadian Family Physicians, PLLC | Current | Accepting new patients | |
| Langlade Hospital - Hotel Dieu of St Joseph of Antigo Wisconsin | Family Medicine | Current | Accepting new patients |
| Aspirus Keweenaw | Current | Accepting new patients | |
| Aspirus Merrill Hospital & Clinics, Inc. | Current | Accepting new patients | |
| Aspirus Medical Group, Inc. | Current | Accepting new patients | |
| Southwest Health System Inc | Current | Accepting new patients | |
| Southwest Health System, Inc. | Current | Accepting new patients | |
| Divine Savior Healthcare, Inc. | Current | Accepting new patients | |
| Aspirus Keweenaw | Current | Accepting new patients | |
| Aspirus Medford Hospital & Clinics, Inc. | Current | Accepting new patients | |
| Texas Heart Hospital of the Southwest LLP | Current | Accepting new patients | |
| Aspirus Ironwood Hospital & Clinics, Inc. | Current | Accepting new patients | |
| Dewitt Medical District | Current | Accepting new patients |
Locations (25 of 65)
520 Rose Ln
Wickenburg, AZ 85390
Phone (928) 666-1197
1311 N Mildred Rd
Cortez, CO 81321
Phone (970) 565-6666
1501 E 3rd St
Delta, CO 81416
Phone (970) 874-2470
5575 Dtc Pkwy
Ste 225
Greenwood Village, CO 80111
1008 Minnequa Ave
Pueblo, CO 81004
Phone (719) 557-5656
2100 NW 35th Avenue Rd
Ocala, FL 34475
Phone (352) 280-7400
10435 SE 170th Pl
Summerfield, FL 34491
Phone (352) 245-7788
1720 Central Ave E
Ste A
Hampton, IA 50441
Phone 3033901940 ext. 86349
1111 11th St
Hawarden, IA 51023
Phone (712) 551-3100
29980 Network Pl
Chicago, IL 60673
194 E Main St
Fort Kent, ME 04743
Phone (207) 834-3101
20 Hartford St
Houlton, ME 04730
Phone (207) 532-2900
140 Academy St
Presque Isle, ME 04769
Phone (207) 768-4000
140 Academy St
#10
Presque Isle, ME 04769
Phone (207) 764-3734
140 Academy St
Ste 10
Presque Isle, ME 04769
Phone (207) 764-3734
140 Academy St
Ste 11
Presque Isle, ME 04769
Phone (207) 764-1898
1000 Cedar St
Houghton, MI 49931
Phone (906) 482-8201
814 S Ice Lake Rd
Iron River, MI 49935
Phone (715) 847-2022
1400 W Ice Lake Rd
Iron River, MI 49935
Phone (906) 265-6121
N10565 Grandview Ln
Ironwood, MI 49938
Phone (906) 932-1500
N10561 Grandview Ln
Ironwood, MI 49938
Phone (906) 932-1500
205 Osceola St
Laurium, MI 49913
Phone (906) 337-3100
210 9th St SE
Rochester, MN 55904
Phone (507) 529-6616
1650 4th St SE
Rochester, MN 55904
Phone (507) 285-8485
1900 Sunrise Dr
Saint Peter, MN 56082
Phone (507) 931-2200
Networks
- Optimum HealthCare HMO Network
- Freedom Health HMO Network
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/AAIAAA
- mshah611516@direct.froedtert.com
- mshah734927@direct.shands.ufl.edu
- manishashah@mmc.medalliesdirect.net
Ownership & related parties
All facility ownership & control disclosures 4
Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.
| Facility | Type | Role | Since |
|---|---|---|---|
| Baylor Scott & White the Heart Hospital - Plano | Hospital | General Partnership Interest | Nov 21, 2013 |
| Baylor Scott & White the Heart Hospital - Denton | Hospital | General Partnership Interest | Nov 21, 2013 |
| Baylor Scott & White the Heart Hospital Rehabilitation | Hospital | General Partnership Interest | Nov 1, 2024 |
| Baylor Scott & White the Heart Hospital - Corinth | Hospital | General Partnership Interest | Nov 1, 2024 |
Owned or controlled facilities with NPI records 4
Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.
-
- General Acute Care Hospital
- Plano, TX
- NPI 1962504340
General Partnership Interest
-
- Rehabilitation Hospital Unit
- Denton, TX
- NPI 1033938451
General Partnership Interest
-
- General Acute Care Hospital
- Denton, TX
- NPI 1194753590
General Partnership Interest
-
- General Acute Care Hospital
- Denton, TX
- NPI 1669213831
General Partnership Interest
Organizations & group practices 71
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.
-
- General Acute Care Hospital
- Toppenish, WA
- NPI 1851817308
-
- Internal Medicine Physician
- Menomonee Falls, WI
- NPI 1568787448
-
- Cardiovascular Disease Physician
- Denton, TX
- NPI 1881010049
-
- General Acute Care Hospital
- Presque Isle, ME
- NPI 1396858999
-
- Surgery Physician
- Leesburg, FL
- NPI 1700669926
Cardiovascular Disease
-
- Rural Health Clinic/Center
- Sunnyside, WA
- NPI 1679521637
-
- Clinic/Center
- Rochester, MN
- NPI 1952356297
-
- Internal Medicine Physician
- Jackson, TN
- NPI 1053615955
-
- Critical Access Hospital
- Eagle River, WI
- NPI 1346204385
-
- Critical Access Hospital
- Iron River, MI
- NPI 1497750830
-
- Critical Access Hospital
- Ironwood, MI
- NPI 1649297342
Hospital & facility affiliations 7
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Critical Access Hospital
- Fort Kent, ME
- NPI 1568465144
-
- General Acute Care Hospital
- Denton, TX
- NPI 1003883158
-
- General Acute Care Hospital
- Plano, TX
- NPI 1962504340
-
- General Acute Care Hospital
- Presque Isle, ME
- NPI 1396858999
-
- General Acute Care Hospital
- Denton, TX
- NPI 1194753590
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161907200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1782259200000",
"number": "1215012000",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6717 CLEAR SPRINGS CIR",
"city": "GARLAND",
"state": "TX",
"postal_code": "750442826",
"telephone_number": "940-765-8484",
"fax_number": "940-220-7527"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1016 TACOMA AVE",
"city": "SUNNYSIDE",
"state": "WA",
"postal_code": "989442263",
"telephone_number": "509-837-1500",
"fax_number": "509-837-4908"
}
],
"practiceLocations": [
{
"address_1": "194 E Main St",
"address_purpose": "LOCATION",
"city": "Fort Kent",
"state": "ME",
"postal_code": "047431428",
"country_code": "US",
"telephone_number": "303-390-1940",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1900 Sunrise Dr",
"address_purpose": "LOCATION",
"city": "Saint Peter",
"state": "MN",
"postal_code": "560825376",
"country_code": "US",
"telephone_number": "303-390-1940",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "502 W 4th Ave",
"address_purpose": "LOCATION",
"city": "Toppenish",
"state": "WA",
"postal_code": "989481616",
"country_code": "US",
"telephone_number": "509-865-3105",
"fax_number": "509-865-1519",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "18797 Alberta St",
"address_purpose": "LOCATION",
"city": "Oneida",
"state": "TN",
"postal_code": "378412127",
"country_code": "US",
"telephone_number": "303-390-1940",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1008 Minnequa Ave",
"address_purpose": "LOCATION",
"city": "Pueblo",
"state": "CO",
"postal_code": "810043733",
"country_code": "US",
"telephone_number": "303-390-1940",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1111 11th St",
"address_purpose": "LOCATION",
"city": "Hawarden",
"state": "IA",
"postal_code": "510231903",
"country_code": "US",
"telephone_number": "303-390-1940",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "301 Riverview Ave Ste 700",
"address_purpose": "LOCATION",
"city": "Norfolk",
"state": "VA",
"postal_code": "235101065",
"country_code": "US",
"telephone_number": "757-252-9365",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1650 4th St SE",
"address_purpose": "LOCATION",
"city": "Rochester",
"state": "MN",
"postal_code": "559044717",
"country_code": "US",
"telephone_number": "507-529-6600",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "333 E 2nd St",
"address_purpose": "LOCATION",
"city": "Richland Center",
"state": "WI",
"postal_code": "535811914",
"country_code": "US",
"telephone_number": "303-390-1940",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "3537 S I 35 E Ste 220",
"address_purpose": "LOCATION",
"city": "Denton",
"state": "TX",
"postal_code": "762106813",
"country_code": "US",
"telephone_number": "972-765-8484",
"fax_number": "940-220-7527",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1311 N Mildred Rd",
"address_purpose": "LOCATION",
"city": "Cortez",
"state": "CO",
"postal_code": "813212231",
"country_code": "US",
"telephone_number": "303-390-1940",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "800 S Fillmore St",
"address_purpose": "LOCATION",
"city": "Osceola",
"state": "IA",
"postal_code": "502131669",
"country_code": "US",
"telephone_number": "303-390-1940",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1755 N Mecklenburg Ave",
"address_purpose": "LOCATION",
"city": "South Hill",
"state": "VA",
"postal_code": "239704080",
"country_code": "US",
"telephone_number": "434-447-3151",
"fax_number": "434-584-4023",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1720 Central Ave E Ste A",
"address_purpose": "LOCATION",
"city": "Hampton",
"state": "IA",
"postal_code": "504411867",
"country_code": "US",
"telephone_number": "303-390-1940",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "939 Caroline St",
"address_purpose": "LOCATION",
"city": "Port Angeles",
"state": "WA",
"postal_code": "983623909",
"country_code": "US",
"telephone_number": "303-390-1940",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "20 Hartford St",
"address_purpose": "LOCATION",
"city": "Houlton",
"state": "ME",
"postal_code": "047301891",
"country_code": "US",
"telephone_number": "303-390-1940",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "2100 NW 35th Avenue Rd",
"address_purpose": "LOCATION",
"city": "Ocala",
"state": "FL",
"postal_code": "344754630",
"country_code": "US",
"telephone_number": "352-280-7400",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "SHAH",
"first_name": "MANISHA",
"middle_name": "JAY",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-10-27",
"last_updated": "2026-06-24",
"certification_date": "2026-06-24",
"status": "A"
},
"taxonomies": [
{
"code": "207RC0000X",
"taxonomy_group": "",
"desc": "Internal Medicine, Cardiovascular Disease",
"state": "MN",
"license": "81548",
"primary": false
},
{
"code": "207RC0000X",
"taxonomy_group": "",
"desc": "Internal Medicine, Cardiovascular Disease",
"state": "TX",
"license": "J8767",
"primary": false
},
{
"code": "207RC0000X",
"taxonomy_group": "",
"desc": "Internal Medicine, Cardiovascular Disease",
"state": "VA",
"license": "0101271026",
"primary": false
},
{
"code": "207RC0000X",
"taxonomy_group": "",
"desc": "Internal Medicine, Cardiovascular Disease",
"state": "TN",
"license": "62629",
"primary": false
},
{
"code": "207RC0000X",
"taxonomy_group": "",
"desc": "Internal Medicine, Cardiovascular Disease",
"state": "CO",
"license": "CDR.0003889",
"primary": false
},
{
"code": "207RC0000X",
"taxonomy_group": "",
"desc": "Internal Medicine, Cardiovascular Disease",
"state": "WA",
"license": "MD61345543",
"primary": true
},
{
"code": "207RC0000X",
"taxonomy_group": "",
"desc": "Internal Medicine, Cardiovascular Disease",
"state": "IA",
"license": "MD-56384",
"primary": false
},
{
"code": "207RC0000X",
"taxonomy_group": "",
"desc": "Internal Medicine, Cardiovascular Disease",
"state": "ME",
"license": "MD27359",
"primary": false
},
{
"code": "207RC0000X",
"taxonomy_group": "",
"desc": "Internal Medicine, Cardiovascular Disease",
"state": "WI",
"license": "2475-320",
"primary": false
},
{
"code": "207RC0000X",
"taxonomy_group": "",
"desc": "Internal Medicine, Cardiovascular Disease",
"state": "FL",
"license": "ME169276",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2259012",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Sunnyside, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.