Individual provider Active NPI

John Mark Beard, MD

  • Family Medicine Physician
  • Mukilteo, WA
National Provider Identifier
1225118201
Registry record updated Mar 15, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD00025677 Issued in WA
Practice address
4410 106TH St SW
Mukilteo, WA 98275-4700
Phone
(425) 493-6000
NPI assigned
Oct 16, 2006
Last updated
Mar 15, 2017By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 15, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MD00025677 WA Primary
Sports Medicine (Family Medicine) Physician 207QS0010X MD00025677 WA

Addresses

Primary practice location

4410 106TH St SW
Mukilteo, WA 98275-4700

Mailing address

PO Box 5127
Everett, WA 98206-5127
Phone (425) 493-6000

Other identifiers 4

IdentifierTypeStateIssuer
1005385MedicaidWA
0230703OtherWAL&I
2005974OtherINTERNAL ID-MOTOR VEHICLE ID
1225118201MedicaidWA

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
I20040223000629 WA Practitioner - Family Practice 1254227838 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Missouri, Columbia School of Medicine, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

100 E Jackson Ave
Ellensburg, WA 98926-3692
Phone (509) 933-8777

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD00025677WAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Optum Care Washington PLLC Family Medicine CurrentSince Jan 9, 2017 Accepting new patients
Kittitas County Public Hospital Dist 1 Current Accepting new patients
Kittitas County Public Hosp Dist 1 CurrentSince Mar 7, 2022 Accepting new patients
Kittitas County Public Hospital Dist 1 CurrentSince Mar 7, 2022 Accepting new patients
Optum Care Washington PLLC Family Medicine CurrentSince Jan 9, 2017 Accepting new patients
Kittitas County Public Hospital Dist 1 Past Accepting new patients

Locations

100 E Jackson Ave
Ellensburg, WA 98926
Phone (509) 574-6000

603 S Chestnut St
Ellensburg, WA 98926
Phone (509) 933-8693

1330 Rockefeller Ave
Everett, WA 98201
Phone (425) 258-3903

4410 106th St SW
Mukilteo, WA 98275
Phone (206) 388-6000

1201 N 175th St
Shoreline, WA 98133
Phone (425) 339-4299

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1160956800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1489536000000",
    "number": "1225118201",
    "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": "425-493-6000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4410 106TH ST SW",
            "city": "MUKILTEO",
            "state": "WA",
            "postal_code": "982754700",
            "telephone_number": "425-493-6000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BEARD",
        "first_name": "JOHN",
        "middle_name": "MARK",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-16",
        "last_updated": "2017-03-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "MD00025677",
            "primary": true
        },
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "WA",
            "license": "MD00025677",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1005385",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "L&I",
            "identifier": "0230703",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INTERNAL ID-MOTOR VEHICLE ID",
            "identifier": "2005974",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1225118201",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mukilteo, WA

Sources for this page

Verify at the official NPI Registry.