Individual provider Active NPI

A Shuravloff, DO

  • Family Medicine Physician
  • Idaho Falls, ID
National Provider Identifier
1255919734
Registry record updated Sep 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
OP61542694 Issued in WA
Practice address
3100 Channing Way
Idaho Falls, ID 83404-7533
Phone
(208) 529-6111
NPI assigned
Mar 29, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 12, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X OP61542694 WA Primary

Addresses

Primary practice location

3100 Channing Way
Idaho Falls, ID 83404-7533

Mailing address

30207 US 2
Sultan, WA 98294-8693
Phone (360) 793-0201

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
I20240822000184 WA Practitioner - Family Practice 5193124501 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Pacific NW Un of HS, Col of Osteopathic Medicine, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

12040 NE 128TH St
Kirkland, WA 98034-3013
Phone (425) 899-2560

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
86.73 of 100Reported as apm
Quality
73.46
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
OP61542694WAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
King County Public Hospital District No. 2 Family Medicine CurrentSince Aug 1, 2024 Accepting new patients
King County Public Hospital District No 2 Family Medicine Current Accepting new patients
King County Public Hospital District No. 2 CurrentSince Aug 1, 2024 Accepting new patients
King County Public Hospital District No 2 Current Accepting new patients
King County Public Hospital District No 2 Past Accepting new patients

Locations

1909 214th St SE
Ste 110
Bothell, WA 98021
Phone (425) 488-4988

14720 Main St NE
Ste 109
Duvall, WA 98019
Phone (425) 788-4889

12040 NE 128th St
Kirkland, WA 98034
Phone (425) 899-1000

12040 NE 128th St
#50
Kirkland, WA 98034
Phone (425) 899-1894

30207 US 2
#139
Sultan, WA 98294

30207 US 2
Sultan, WA 98294
Phone (360) 793-0201

Interoperability endpoints

  • Direct secure messaging: a.shuravloff.1@16437.direct.athenahealth.com

Organizations & group practices 5

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 4

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": "1616976000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726099200000",
    "number": "1255919734",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30207 US 2",
            "city": "SULTAN",
            "state": "WA",
            "postal_code": "982948693",
            "telephone_number": "360-793-0201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3100 CHANNING WAY",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834047533",
            "telephone_number": "208-529-6111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHURAVLOFF",
        "first_name": "A",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-03-29",
        "last_updated": "2024-09-12",
        "certification_date": "2024-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "OP61542694",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Idaho Falls, ID

Sources for this page

Verify at the official NPI Registry.