NPIMap

Individual provider Active NPI

Ken Haberman, MD

  • Urology Physician
  • Federal Way, WA
National Provider Identifier
1225290489
Registry record updated Sep 25, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
A119113 Issued in CA
Practice address
34612 6TH Ave S
Suite 210
Federal Way, WA 98003-8723
Phone
(253) 927-1882
Fax
(253) 927-1439
NPI assigned
Jun 30, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 25, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X A119113 CA Primary

Addresses

Primary practice location

34612 6TH Ave S
Suite 210
Federal Way, WA 98003-8723

Mailing address

34612 6TH Ave S
Suite 110
Federal Way, WA 98003-8723
Phone (253) 927-1882

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130717000081 WA Practitioner - Urology 7810153335 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
University of Texas Southwestern Medical School at Dallas, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Surgical Associates Northwest PCGroup PAC ID 3971596024, 13 clinicians

Practice addresses (Care Compare)

34612 6TH Ave S
Suite 210
Federal Way, WA 98003-8723
Phone (253) 927-1882

Hospital & facility affiliations

  • St Francis Community Hospital Hospital, Federal Way, WA, CCN 500141
  • Multicare Auburn Medical Center Hospital, Auburn, WA, CCN 500015
  • Tacoma General Allenmore Hospital Hospital, Tacoma, WA, CCN 500129
  • St Joseph Medical Center Hospital, Tacoma, WA, CCN 500108
  • Multicare Covington Medical Center Hospital, Covington, WA, CCN 500154

Procedures performed for Medicare patients

ProcedureNumber of procedures
Prostate resection1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Surgical Associates Northwest, P.C. Urology CurrentSince Jul 1, 2013 Accepting new patients
Surgical Associates Northwest, PC CurrentSince Jul 1, 2013 Accepting new patients

Locations

202 N Division St
Ste 100
Auburn, WA 98001
Phone (253) 223-0515

34612 6th Ave S
Ste 110
Federal Way, WA 98003
Phone (253) 661-2594

34612 6th Ave S
Ste 210
Federal Way, WA 98003
Phone (253) 927-1882

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/2229/brand/3/csg/621/fhir/r4
  • Direct secure messaging: kenhaberman@sa.allscriptsdirect.net

Organizations & group practices 2

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.

Hospital & facility affiliations 9

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": "1214784000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1380067200000",
    "number": "1225290489",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "34612 6TH AVE S",
            "address_2": "SUITE 110",
            "city": "FEDERAL WAY",
            "state": "WA",
            "postal_code": "980038723",
            "telephone_number": "253-927-1882",
            "fax_number": "253-927-1439"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "34612 6TH AVE S",
            "address_2": "SUITE 210",
            "city": "FEDERAL WAY",
            "state": "WA",
            "postal_code": "980038723",
            "telephone_number": "253-927-1882",
            "fax_number": "253-927-1439"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HABERMAN",
        "first_name": "KEN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-06-30",
        "last_updated": "2013-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "CA",
            "license": "A119113",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Federal Way, WA

Sources for this page

Verify at the official NPI Registry.