Individual provider Active NPI

Kenneth Y Igbalode, MD

  • Cardiovascular Disease Physician
  • Renton, WA
National Provider Identifier
1235577883
Registry record updated Aug 4, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
MD61041046 Issued in WA
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

Updated by the provider on Aug 4, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
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

IdentifierTypeStateIssuer
2160257MedicaidWA

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
I20200811000667 WA Practitioner - Cardiovascular Disease (Cardiology) 2769619949 Reassigns benefits to 5 organizations

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
Franciscan Medical GroupGroup PAC ID 0547173866, 1,400 clinicians
Valley Medical Group-RentonGroup PAC ID 4183753965, 419 clinicians

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 Hospital, Renton, WA, CCN 500088

Procedures performed for Medicare patients

ProcedureNumber of procedures
Coronary angioplasty and stenting1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
L-255187MAMDInternal Medicine Physician
MD61041046WAMDCardiovascular Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Capital Medical Center Specialty Physicians, LLC CurrentSince Apr 29, 2021 Accepting new patients
Valley Medical Group-Renton Internal Medicine CurrentSince Aug 4, 2020 Accepting new patients
Multicare Health System CurrentSince Apr 29, 2021 Accepting new patients
Multicare Health System CurrentSince Apr 29, 2021 Accepting new patients
Grays Harbor Community Hospital CurrentSince Dec 15, 2022 Accepting new patients
Franciscan Medical Group Internal Medicine CurrentSince May 19, 2025 Accepting new patients
Franciscan Medical Group Current Accepting new patients
Multicare Health System Current Accepting new patients
GHCH Physician Services, LLC Internal Medicine CurrentSince Dec 15, 2022 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

  • Direct secure messaging: 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.

Hospital & facility affiliations 2

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": "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

Verify at the official NPI Registry.