NPIMap

Organization Active NPI

Wadsworth Psychiatric Services PLLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Issaquah, WA
National Provider Identifier
1225566417
Registry record updated Aug 2, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
AP60720812 Issued in WA
Legal business name
WADSWORTH PSYCHIATRIC SERVICES PLLC
Practice address
6520 226TH PL SE Ste 203
Issaquah, WA 98027-8969
Phone
(425) 222-1000
Fax
(425) 651-2973
NPI assigned
Jun 1, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 2, 2019

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

Authorized official

Name
Brett Lee Wadsworth, PMHNPNPI 1649727249
Title
Arnp
Phone
(425) 222-1000

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LP0808X AP60720812 WA Primary

Addresses

Primary practice location

6520 226TH PL SE Ste 203
Issaquah, WA 98027-8969

Mailing address

6520 226TH PL SE Ste 203
Issaquah, WA 98027-8969
Phone (425) 222-1000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170802003202 WA Part B Supplier - Clinic/Group Practice 7911278379 Receives reassigned benefits from 1 practitioner
Practice locations: Bellevue, WA

National Provider Directory

National Provider Directory

Locations

6520 226th Pl SE
Ste 203
Issaquah, WA 98027
Phone (425) 222-1000

22500 SE 64th Pl
Ste 150
Issaquah, WA 98027
Phone (425) 222-1000

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1496275200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1564704000000",
    "number": "1225566417",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6520 226TH PL SE STE 203",
            "city": "ISSAQUAH",
            "state": "WA",
            "postal_code": "980278969",
            "telephone_number": "425-222-1000",
            "fax_number": "425-651-2973"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6520 226TH PL SE STE 203",
            "city": "ISSAQUAH",
            "state": "WA",
            "postal_code": "980278969",
            "telephone_number": "425-222-1000",
            "fax_number": "425-651-2973"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WADSWORTH PSYCHIATRIC SERVICES PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-06-01",
        "last_updated": "2019-08-02",
        "status": "A",
        "authorized_official_last_name": "WADSWORTH",
        "authorized_official_first_name": "BRETT",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "ARNP",
        "authorized_official_telephone_number": "425-222-1000",
        "authorized_official_credential": "PMHNP"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "WA",
            "license": "AP60720812",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Issaquah, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.