NPIMap

Individual provider Active NPI

Daryl Sudasena

  • Interventional Cardiology Physician
  • Olympia, WA
National Provider Identifier
1295153880
Registry record updated May 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Cardiology PhysicianTaxonomy code 207RI0011X
License
MD61145791 Issued in WA
Practice address
406 Black Hills LN SW
Olympia, WA 98502-8143
Phone
(360) 754-1735
NPI assigned
Apr 1, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 3, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X R9445 TX
Cardiovascular Disease Physician 207RC0000X 307858 NY
Interventional Cardiology Physician 207RI0011X MD61145791 WA Primary

Addresses

Primary practice location

406 Black Hills LN SW
Olympia, WA 98502-8143

Mailing address

406 Black Hills LN SW
Olympia, WA 98502-8143
Phone (360) 754-1735

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210810001151 WA Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Interventional Cardiology 7012132020 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)Also: Interventional Cardiology
Education
Saint Louis University School of Medicine, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Yakima Valley Memorial PhysiciansGroup PAC ID 1557391596, 397 clinicians
Public Hospital Dist No 1 SkagitGroup PAC ID 6800793522, 321 clinicians
Multicare Health SystemGroup PAC ID 7719899897, 2,312 clinicians

Practice addresses (Care Compare)

2811 Tieton Dr
Yakima, WA 98902-3761
Phone (509) 575-8000

307 S 13TH St
Suite 300
Mount Vernon, WA 98274-4100
Phone (360) 336-9757

311 S L St
Tacoma, WA 98405-3720

406 S 30TH Ave
Yakima, WA 98902-3713

4700 Point Fosdick Dr
Gig Harbor, WA 98335-1706

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Coronary angioplasty and stenting38
Pacemaker insertion or repair1-10
Leg revascularization (restoring blood flow)1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
R9445TXMDInternal Medicine Physician
MD61145791WAMDInterventional Cardiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Olympia Multi Specialty Clinic CurrentSince Aug 1, 2021 Accepting new patients
Public Hospital Dist No 1 Skagit CurrentSince Dec 29, 2025 Accepting new patients
Multicare Health System Current Accepting new patients
Multicare Health System CurrentSince Oct 1, 2025 Accepting new patients
Yakima Valley Memorial Physicians CurrentSince May 13, 2025 Accepting new patients
Lewis County Hospital District No. 1 CurrentSince Jan 1, 2025 Accepting new patients
Public Hospital Dist No 1 Skagit CurrentSince Dec 29, 2025 Accepting new patients
Southeast Iowa Regional Medical Center, Inc. CurrentSince Apr 7, 2025 Accepting new patients
Yakima Valley Memorial Physicians CurrentSince May 13, 2025 Accepting new patients
Yakima Valley Memorial Physicians Current Accepting new patients
Lewis County Hospital District No. 1 CurrentSince Jan 1, 2025 Accepting new patients
Multicare Health System CurrentSince Oct 1, 2025 Accepting new patients
Multicare Health System Past Accepting new patients

Locations

407 S White St
Mt Pleasant, IA 52641
Phone (319) 385-6110

1221 S Gear Ave
West Burlington, IA 52655
Phone (319) 768-3622

1223 S Gear Ave
Ste 109
West Burlington, IA 52655
Phone (319) 753-5474

4700 Point Fosdick Dr
Ste 104
Gig Harbor, WA 98335
Phone (253) 459-7590

1400 E Kincaid St
Mount Vernon, WA 98274
Phone (360) 428-2586

307 S 13th St
Ste 300
Mount Vernon, WA 98274
Phone (360) 336-9757

406 Black Hills Ln SW
Ste A
Olympia, WA 98502
Phone (360) 754-1727

406 Black Hills Ln SW
Olympia, WA 98502
Phone (360) 704-3450

311 S L St
Tacoma, WA 98405
Phone (253) 403-1444

406 S 30th Ave
Ste 101
Yakima, WA 98902
Phone (509) 248-7715

2811 Tieton Dr
Yakima, WA 98902
Phone (509) 249-5210

406 S 30th Ave
Yakima, WA 98902
Phone (509) 248-7715

Organizations & group practices 15

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.

View all 15

Hospital & facility affiliations 6

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": "1396310400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1651536000000",
    "number": "1295153880",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "406 BLACK HILLS LN SW",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985028143",
            "telephone_number": "360-754-1735"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "406 BLACK HILLS LN SW",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985028143",
            "telephone_number": "360-754-1735"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUDASENA",
        "first_name": "DARYL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-04-01",
        "last_updated": "2022-05-03",
        "certification_date": "2022-05-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "R9445",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "NY",
            "license": "307858",
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "WA",
            "license": "MD61145791",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Olympia, WA

Sources for this page

Verify at the official NPI Registry.