NPIMap

Organization Active NPI

Fairhaven Family Medicine

  • Family Medicine Physician
  • Burlington, WA
National Provider Identifier
1215041637
Registry record updated Jan 7, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD00023548 Issued in WA
Legal business name
FAIRHAVEN FAMILY MEDICINE
Practice address
1030 East Fairhaven Avenue
Burlington, WA 98233
Phone
(360) 755-0311
Fax
(360) 755-1272
NPI assigned
Aug 19, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 7, 2009

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

Authorized official

Name
Dr. Stephen M Aldrich, MDNPI 1528172947
Title
MD
Phone
(360) 755-0311

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X MD00013642 WA
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X MD00023548 WA Primary

Addresses

Primary practice location

1030 East Fairhaven Avenue
Burlington, WA 98233

Mailing address

PO Box 468
Burlington, WA 98233
Phone (360) 755-0311

Other identifiers 2

IdentifierTypeStateIssuer
S57930OtherWAREGENCE BLUE SHIELD
7816200MedicaidWA

National Provider Directory

National Provider Directory

Locations

1030 E Fairhaven Ave
Burlington, WA 98233
Phone (360) 755-0311

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/24838/brand/2/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 2

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": "1155945600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1231286400000",
    "number": "1215041637",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 468",
            "city": "BURLINGTON",
            "state": "WA",
            "postal_code": "98233",
            "telephone_number": "360-755-0311",
            "fax_number": "360-755-1272"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1030 EAST FAIRHAVEN AVENUE",
            "city": "BURLINGTON",
            "state": "WA",
            "postal_code": "98233",
            "telephone_number": "360-755-0311",
            "fax_number": "360-755-1272"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIRHAVEN FAMILY MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-19",
        "last_updated": "2009-01-07",
        "status": "A",
        "authorized_official_last_name": "ALDRICH",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "360-755-0311",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "MD00013642",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "MD00023548",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE BLUE SHIELD",
            "identifier": "S57930",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7816200",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Burlington, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2009; 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.