Russom Desta, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

MD61579314 Issued in WA

Practice address

3901 Hoyt Ave
Everett, WA 98201-4918

Phone

(425) 261-4076

Fax

(425) 261-4078

NPI assigned

Apr 5, 2022

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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

Specialty

Hospitalist

Education

Meharry Medical College School of Medicine, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Providence Health and Services- WashingtonGroup PAC ID 8325100480, 527 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Providence Regional Medical Center Everett Hospital, Everett, WA, CCN 500014

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: rdesta100306@direct.tecmc.com

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.

• Providence Health & Services- Washington

  dba PMG NW Wa

  • General Practice Physician
  • Everett, WA
  • NPI 1124270715
  Medicare reassignment Care Compare group NPD
• Optum Care Washington PLLC

  • Multi-Specialty Clinic/Center
  • Everett, WA
  • NPI 1831186766

  Internal Medicine

  Medicare reassignment NPD
• The Polyclinic PLLC

  dba Optum - Broadway

  • Audiologist
  • Seattle, WA
  • NPI 1174594634

  Internal Medicine

  Medicare reassignment NPD
• Optum Care Washington PLLC

  • Durable Medical Equipment & Medical Supplies
  • Marysville, WA
  • NPI 1194428425

  Internal Medicine

  NPD
• The Polyclinic PLLC

  dba Optum Tacoma

  • Durable Medical Equipment & Medical Supplies
  • Tacoma, WA
  • NPI 1831411487

  Internal Medicine

  NPD
• Providence Health & Services-Wa

  • General Acute Care Hospital
  • Everett, WA
  • NPI 1700037801
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Providence Health & Services-Wa

  dba Providence Regional Medical Center Everett

  • Hospitalist Physician
  • Everett, WA
  • NPI 1649615220
  Care Compare affiliation
• Providence Health & Services-Wa

  • General Acute Care Hospital
  • Everett, WA
  • NPI 1700037801
  Care Compare affiliation

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

{
    "created_epoch": "1649116800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1758585600000",
    "number": "1245971209",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5127",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982065127",
            "telephone_number": "206-860-5414",
            "fax_number": "206-720-8462"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3901 HOYT AVE",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982014918",
            "telephone_number": "425-261-4076",
            "fax_number": "425-261-4078"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1959 NE Pacific St",
            "address_purpose": "LOCATION",
            "city": "Seattle",
            "state": "WA",
            "postal_code": "981950001",
            "country_code": "US",
            "telephone_number": "206-543-3605",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DESTA",
        "first_name": "RUSSOM",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-04-05",
        "last_updated": "2025-09-23",
        "certification_date": "2025-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WA",
            "license": "MD61579314",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Suzanne M Deselms, CD(DONA)
• Alicia D Deshields
• Ayesha Desilva
• Alicia Desmarais, PT
• Mary M Dessein, BA
• Daniel Louis Destito, RPH
• Debbie Susan Desy, LMP
• Jeffrey Dettman
• Madison D Dettmer, LMP
• Jason Dettori, M.D.

• Internal Medicine Physician in Everett, WA
• Providers in Everett, WA by specialty
• Internal Medicine Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2025; 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.

Verify at the official NPI Registry.