NPIMap

Organization Active NPI

Seattle Indian Health Board

  • Federally Qualified Health Center (FQHC)
  • Seattle, WA
National Provider Identifier
1235778812
Registry record updated Sep 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
SEATTLE INDIAN HEALTH BOARD
Practice address
124 2ND Ave S
Seattle, WA 98104-5168
Phone
(206) 292-6214
NPI assigned
Dec 31, 2019
Last updated
Sep 15, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
SEATTLE INDIAN HEALTH BOARDAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 15, 2022

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

Authorized official

Name
Yvette Yazzie, DO
Title
Credentialing
Phone
(206) 324-9360

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary
Family Medicine Physician 207Q00000X

Addresses

Primary practice location

124 2ND Ave S
Seattle, WA 98104-5168

Mailing address

611 12TH Ave S
Seattle, WA 98144-2007
Phone (206) 324-9360

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040105000550 WA Part B Supplier - Clinic/Group Practice 7517866973 Receives reassigned benefits from 56 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Seattle, WA
O20230227002656 WA Part A Provider - Federally Qualified Health Center (FQHC) 7517866973 Practice locations: Seattle, WA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1235778812. Details of each certification follow.

Federally qualified health center certification: CCN 501024

Legal name
SEATTLE INDIAN HEALTH BOARD
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 14, 2023
Last certification
Mar 14, 2023
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
124 2ND Ave S
Seattle, WA 98104-5168

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Seattle Indian Health Board17 organizations share this tax ID, including this one
Part of
Seattle Indian Health Board

Other organizations with this tax ID 16

Organizations that report the same tax identification number in the National Provider Directory.

View all 16

Ownership & related parties

All disclosed owners & managing parties 9

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Pamela Grindley Individual Corporate OfficerChro Sep 6, 2016
W-2 Managing Employee Jan 1, 2021
Operational/Managerial Control Sep 6, 2016
Esther Lucero Individual 5% Or Greater Direct Ownership Interest Nov 9, 2015
Corporate OfficerCeo Nov 9, 2015
Operational/Managerial Control Nov 5, 2015
Alix Anderson Individual Corporate Director Feb 1, 2017
Sharyne Thornton Individual Corporate DirectorVice President Aug 1, 1992
Cornelius W Vanniel Individual Corporate Director Jun 1, 1997
Tom Warren Individual Corporate DirectorBoard President Jan 1, 2015
Jania Garcia Individual Corporate DirectorBoard Secretary Jan 7, 2017
Shelly Means Individual Corporate Director Mar 1, 2017
Armilito Pangilinan Individual Corporate Director Sep 1, 2017

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Seattle Indian Health BoardSeattle, WA, CCN 501805 Federally qualified health center Operational/Managerial Control Dec 6, 2010

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 9

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": "1577750400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1663200000000",
    "number": "1235778812",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "611 12TH AVE S",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981442007",
            "telephone_number": "206-324-9360",
            "fax_number": "206-899-1682"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "124 2ND AVE S",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981045168",
            "telephone_number": "206-292-6214"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SEATTLE INDIAN HEALTH BOARD",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SEATTLE INDIAN HEALTH BOARD",
        "enumeration_date": "2019-12-31",
        "last_updated": "2022-09-15",
        "certification_date": "2022-09-15",
        "status": "A",
        "authorized_official_last_name": "YAZZIE",
        "authorized_official_first_name": "YVETTE",
        "authorized_official_title_or_position": "CREDENTIALING",
        "authorized_official_telephone_number": "206-324-9360",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Seattle, WA

Sources for this page

Verify at the official NPI Registry.