Individual provider Active NPI

Achsa R Rathvon, DPT

  • Physical Therapist
  • Renton, WA
National Provider Identifier
1306039367
Registry record updated May 13, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT00010482 Issued in WA
Practice address
275 Bronson Way NE
Renton, WA 98056-4030
Phone
(425) 235-2800
Fax
(425) 235-2815
NPI assigned
Aug 23, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 13, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT00010482 WA Primary

Addresses

Primary practice location

275 Bronson Way NE
Renton, WA 98056-4030

Mailing address

790 Remington Blvd
Bolingbrook, IL 60440-4909
Phone (630) 296-2223

Other identifiers 2

IdentifierTypeStateIssuer
0291547OtherWADEPT. OF LABOR AND INDUSTRIES
8488561MedicaidWA

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwa.kp.org:14430/Interconnect-CE-PRD/wcf/epic.community.hie/xcpdrespondinggatewaysync Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070921000382 WA Practitioner - Physical Therapist in Private Practice 7416041439 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

11511 NE 10TH St
Bellevue, WA 98004-8578
Phone (425) 502-3000

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PT00010482WAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Kaiser Foundation Health Plan of Washington CurrentSince Jan 1, 2015 Accepting new patients
Kaiser Foundation Health Plan of Washington CurrentSince Jan 1, 2015 Accepting new patients
Kaiser Foundation Health Plan of Washington Current Accepting new patients

Locations

11511 NE 10th St
Hunts Point, WA 98004
Phone (425) 502-3000

275 Bronson Way NE
Renton, WA 98056
Phone (425) 235-2800

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

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

Organizations & group practices 3

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": "1187827200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620864000000",
    "number": "1306039367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "790 REMINGTON BLVD",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604404909",
            "telephone_number": "630-296-2223"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "275 BRONSON WAY NE",
            "city": "RENTON",
            "state": "WA",
            "postal_code": "980564030",
            "telephone_number": "425-235-2800",
            "fax_number": "425-235-2815"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RATHVON",
        "first_name": "ACHSA",
        "middle_name": "R",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-08-23",
        "last_updated": "2021-05-13",
        "certification_date": "2021-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "PT00010482",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPT. OF LABOR AND INDUSTRIES",
            "identifier": "0291547",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8488561",
            "state": "WA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwa.kp.org:14430/Interconnect-CE-PRD/wcf/epic.community.hie/xcpdrespondinggatewaysync",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "275 Bronson Way NE",
            "city": "Renton",
            "state": "WA",
            "country_code": "US",
            "postal_code": "980564030",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Renton, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.