Active NPI
Kenneth Y Igbalode, MD
- Cardiovascular Disease Physician
- Renton, WA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Cardiovascular Disease Physician
- License
- MD61041046
- Practice address
- 4011 Talbot Rd S Ste 500
Renton, WA 98055-5782 - Phone
- (425) 690-3482
- Fax
- (425) 690-9082
- NPI assigned
- Jun 5, 2013
- 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 |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | L-255187 | MA | |
| Cardiovascular Disease Physician | 207RC0000X | MD61041046 | WA | Primary |
Addresses
Primary practice location
4011 Talbot Rd S Ste 500
Renton, WA 98055-5782
Mailing address
3600 Lind Ave SW
Suite 100 Attn Credentialing
Renton, WA 98057-4970
Phone (425) 690-2715
Other practice location 1
Massachusetts General Hospital
55 Fruit St.
Boston, MA 02114
Phone (617) 726-2865
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2160257 | Medicaid | WA |
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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Cardiovascular Disease (Cardiology)
- Education
- Baylor College of Medicine, 2013
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
16233 Sylvester Rd SW
Suite 260
Burien, WA 98166-3044
Phone (206) 835-7440
4011 Talbot Rd S
Suite 500
Renton, WA 98055-5782
Phone (425) 690-3488
Hospital & facility affiliations
- Valley Medical Center
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Coronary angioplasty and stenting | 1-10 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| L-255187 | MA | MD | Internal Medicine Physician |
| MD61041046 | WA | MD | Cardiovascular Disease Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Capital Medical Center Specialty Physicians, LLC | Current | Accepting new patients | |
| Valley Medical Group-Renton | Internal Medicine | Current | Accepting new patients |
| Multicare Health System | Current | Accepting new patients | |
| Multicare Health System | Current | Accepting new patients | |
| Grays Harbor Community Hospital | Current | Accepting new patients | |
| Franciscan Medical Group | Internal Medicine | Current | Accepting new patients |
| Franciscan Medical Group | Current | Accepting new patients | |
| Multicare Health System | Current | Accepting new patients | |
| GHCH Physician Services, LLC | Internal Medicine | Current | Accepting new patients |
| Public Hospital District #1 of King County | Past | Accepting new patients |
Locations
1211 Skyview Dr
Aberdeen, WA 98520
Phone (360) 532-3808
16233 Sylvester Rd SW
Ste 260
Burien, WA 98166
Phone (206) 244-3363
16850 SE 272nd St
Ste 100
Covington, WA 98042
Phone (253) 395-1971
34503 9th Ave S
Ste 130
Federal Way, WA 98003
Phone (253) 835-5340
4700 Point Fosdick Dr
Ste 104
Gig Harbor, WA 98335
Phone (253) 459-7590
222 State Ave N
Kent, WA 98030
Phone (253) 372-7680
319 E Pioneer Ave
Montesano, WA 98563
Phone (360) 249-1980
3900 Capital Mall Dr SW
Olympia, WA 98502
Phone (360) 704-4743
4011 Talbot Rd S
Ste 500
Renton, WA 98055
Phone (425) 251-5110
3600 Lind Ave SW
Ste 100
Renton, WA 98057
Interoperability endpoints
- kigbalode84997@direct.valleymed.org
Organizations & group practices 10
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.
-
- Orthopaedic Surgery Physician
- Silverdale, WA
- NPI 1093165334
-
- Occupational Medicine Physician
- Olympia, WA
- NPI 1760785281
-
- Neurological Surgery Physician
- Tacoma, WA
- NPI 1497766638
-
- Obstetrics & Gynecology Physician
- Hoquiam, WA
- NPI 1134597693
-
- Family Medicine Physician
- Tacoma, WA
- NPI 1396297487
-
- Community/Retail Pharmacy
- Spokane, WA
- NPI 1396594875
-
- Rehabilitation Hospital Unit
- Renton, WA
- NPI 1811063308
Hospital & facility affiliations 2
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Renton, WA
- NPI 1649209230
-
- General Acute Care Hospital
- Renton, WA
- NPI 1619209574
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1370390400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1596499200000",
"number": "1235577883",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3600 LIND AVE SW",
"address_2": "SUITE 100 ATTN CREDENTIALING",
"city": "RENTON",
"state": "WA",
"postal_code": "980574970",
"telephone_number": "425-690-2715"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4011 TALBOT RD S STE 500",
"city": "RENTON",
"state": "WA",
"postal_code": "980555782",
"telephone_number": "425-690-3482",
"fax_number": "425-690-9082"
}
],
"practiceLocations": [
{
"address_1": "Massachusetts General Hospital",
"address_2": "55 Fruit St.",
"address_purpose": "LOCATION",
"city": "Boston",
"state": "MA",
"postal_code": "02114",
"country_code": "US",
"telephone_number": "617-726-2865",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "IGBALODE",
"first_name": "KENNETH",
"middle_name": "Y",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-06-05",
"last_updated": "2020-08-04",
"certification_date": "2020-08-04",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "MA",
"license": "L-255187",
"primary": false
},
{
"code": "207RC0000X",
"taxonomy_group": "",
"desc": "Internal Medicine, Cardiovascular Disease",
"state": "WA",
"license": "MD61041046",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2160257",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Renton, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.