Individual provider Active NPI

Blessy Jacob, MD

  • Internal Medicine Physician
  • Bellevue, WA
National Provider Identifier
1295268407
Registry record updated Nov 18, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD61026828 Issued in WA
Practice address
1200 112TH Ave NE Ste B100
Bellevue, WA 98004-3751
Phone
(425) 462-1132
Fax
(425) 456-3668
NPI assigned
Apr 5, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 18, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD61026828 WA Primary

Addresses

Primary practice location

1200 112TH Ave NE Ste B100
Bellevue, WA 98004-3751

Mailing address

PO Box 25608
Salt Lake City, UT 84125-0608
Phone (206) 320-4476

Other identifiers 1

IdentifierTypeStateIssuer
1295268407MedicaidWA

Other names 1

  • Blessy Ann Varghese Former name

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
I20201013003013 WA Practitioner - Internal Medicine 4082034012 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Swedish Health ServicesGroup PAC ID 9537072814, 384 clinicians

Practice addresses (Care Compare)

1200 112TH Ave NE
Suite B100
Bellevue, WA 98004-3751
Phone (425) 462-1132

Hospital & facility affiliations

  • Swedish Issaquah Hospital, Issaquah, WA, CCN 500152
  • Overlake Hospital Medical Center & Clinics Hospital, Bellevue, WA, CCN 500051
  • Evergreenhealth Medical Center Hospital, Kirkland, WA, CCN 500124

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD61026828WAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Swedish Health Services Internal Medicine CurrentSince Nov 1, 2020 Accepting new patients
Swedish Health Services CurrentSince Nov 1, 2020 Accepting new patients

Locations

1200 112th Ave NE
Ste B100
Bellevue, WA 98004
Phone (425) 462-1132

13020 Meridian Ave S
Everett, WA 98208
Phone (425) 357-3700

2450 33rd Ave W
Ste 100
Seattle, WA 98199
Phone (206) 320-3364

800 5th Ave
Ste 600
Seattle, WA 98104

Organizations & group practices 2

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": "1491350400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1605657600000",
    "number": "1295268407",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 25608",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841250608",
            "telephone_number": "206-320-4476",
            "fax_number": "206-568-7043"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 112TH AVE NE STE B100",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980043751",
            "telephone_number": "425-462-1132",
            "fax_number": "425-456-3668"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOB",
        "first_name": "BLESSY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-04-05",
        "last_updated": "2020-11-18",
        "certification_date": "2020-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WA",
            "license": "MD61026828",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1295268407",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BLESSY",
            "last_name": "VARGHESE",
            "middle_name": "ANN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Bellevue, WA

Sources for this page

Verify at the official NPI Registry.