Active NPI
Ryan K Phasouk, MD
- Family Medicine Physician
- Everett, WA
National Provider Identifier
1215946892
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- MD60513668
- Practice address
- 3927 Rucker Ave
Everett, WA 98201-4833 - Phone
- (425) 339-5422
- Fax
- (425) 339-5444
- NPI assigned
- Aug 5, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 036116544 | IL | |
| Family Medicine Physician | 207Q00000X | MD60513668 | WA | Primary |
Addresses
Primary practice location
3927 Rucker Ave
Everett, WA 98201-4833
Mailing address
PO Box 5127
Everett, WA 98206-5127
Phone (425) 304-8431
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2040577 | Medicaid | WA | |
| 336077643 | Other | IL | CONTROLLED SUBSTANCE LICE |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | rphasouk125094@fhsce.catholichealth.net | Direct |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD60513668 | WA | MD | Family Medicine Physician |
Interoperability endpoints
- rphasouk125094@fhsce.catholichealth.net
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154736000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1649030400000",
"number": "1215946892",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 5127",
"city": "EVERETT",
"state": "WA",
"postal_code": "982065127",
"telephone_number": "425-304-8431"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3927 RUCKER AVE",
"city": "EVERETT",
"state": "WA",
"postal_code": "982014833",
"telephone_number": "425-339-5422",
"fax_number": "425-339-5444"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHASOUK",
"first_name": "RYAN",
"middle_name": "K",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-05",
"last_updated": "2022-04-04",
"certification_date": "2022-04-04",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "IL",
"license": "036116544",
"primary": false
},
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "WA",
"license": "MD60513668",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2040577",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CONTROLLED SUBSTANCE LICE",
"identifier": "336077643",
"state": "IL"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "rphasouk125094@fhsce.catholichealth.net",
"affiliation": "N",
"use": "DIRECT",
"useDescription": "Direct",
"address_1": "450 S Kitsap Blvd",
"city": "Port Orchard",
"state": "WA",
"country_code": "US",
"postal_code": "983663773",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Everett, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.