Individual provider Active NPI

Sibani Das

  • Family Medicine Physician
  • Marysville, WA
National Provider Identifier
1275162182
Registry record updated Nov 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD61448008 Issued in WA
Practice address
9710 State Ave
Marysville, WA 98270-2232
Phone
(360) 657-3062
NPI assigned
Apr 2, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 9, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X WA
Family Medicine Physician 207Q00000X MD61448008 WA Primary

Addresses

Primary practice location

9710 State Ave
Marysville, WA 98270-2232

Mailing address

PO Box 34703
Seattle, WA 98124-1703

Other identifiers 1

IdentifierTypeStateIssuer
2165808MedicaidWA

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
I20230515003066 WA Practitioner - Family Practice 4880050954 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Kaiser Foundation Health Plan of WashingtonGroup PAC ID 9032022579, 1,519 clinicians

Practice addresses (Care Compare)

11913 NE 195TH St
Bothell, WA 98011-3147
Phone (425) 489-3174

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD61448008WAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Kaiser Foundation Health Plan of Washington CurrentSince Oct 6, 2023 Accepting new patients
Kaiser Foundation Health Plan of Washington Family Medicine CurrentSince Oct 6, 2023 Accepting new patients
Sea Mar Community Health Centers Family Medicine Current Accepting new patients
Kaiser Foundation Health Plan of Washington Current Accepting new patients
Sea Mar Community Health Centers CurrentSince Feb 7, 2023 Accepting new patients
Sea Mar Community Health Centers Family Medicine CurrentSince Feb 7, 2023 Accepting new patients

Locations

11913 NE 195th St
Bothell, WA 98011
Phone (425) 489-3100

9710 State Ave
Marysville, WA 98270
Phone (360) 653-1742

17707 W Main St
Fl 1
Monroe, WA 98272
Phone (360) 282-3885

200 15th Ave E
Seattle, WA 98112
Phone (206) 326-4530

9505 S Steele St
Tacoma, WA 98444
Phone (253) 597-6800

Interoperability endpoints

  • Direct secure messaging: sdas181994@ghc.direct-ci.net

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1585785600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699488000000",
    "number": "1275162182",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 34703",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981241703",
            "fax_number": "360-657-3057"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9710 STATE AVE",
            "city": "MARYSVILLE",
            "state": "WA",
            "postal_code": "982702232",
            "telephone_number": "360-657-3062"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAS",
        "first_name": "SIBANI",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-04-02",
        "last_updated": "2023-11-09",
        "certification_date": "2023-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "WA",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "MD61448008",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2165808",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Marysville, WA

Sources for this page

Verify at the official NPI Registry.