NPIMap

Individual provider Active NPI

Kamol Lohavanichbutr, MD

  • Interventional Cardiology Physician
  • Mount Vernon, WA
National Provider Identifier
1306880638
Registry record updated Mar 12, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Cardiology PhysicianTaxonomy code 207RI0011X
License
MD00036595 Issued in WA
Practice address
307 S 13TH St
Suite 300
Mount Vernon, WA 98274-4100
Phone
(360) 336-9757
Fax
(360) 814-5237
NPI assigned
Jun 16, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 12, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Interventional Cardiology Physician 207RI0011X MD00036595 WA Primary
Cardiovascular Disease Physician 207RC0000X MD00036595 WA

Addresses

Primary practice location

307 S 13TH St
Suite 300
Mount Vernon, WA 98274-4100

Mailing address

1400 E. Kincaid St.
Attn: Credentialing
Mount Vernon, WA 98274-4127
Phone (360) 428-2500

Other identifiers 1

IdentifierTypeStateIssuer
8417024MedicaidWA

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
I20050217000352 WA Practitioner - Interventional CardiologyPractitioner - Cardiovascular Disease (Cardiology) 8820046618 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Interventional CardiologyAlso: Cardiovascular Disease (Cardiology)
Education
Other, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Public Hospital Dist No 1 SkagitGroup PAC ID 6800793522, 321 clinicians

Practice addresses (Care Compare)

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

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Coronary angioplasty and stenting12
Pacemaker insertion or repair1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Public Hospital Dist No 1 Skagit CurrentSince Nov 1, 2010 Accepting new patients
Missouri Basin Anesthesia, PLLC Past Accepting new patients
St. Alexius Heart & Lung Clinic, LLC Cardiovascular Disease Past Accepting new patients
Public Hospital Dist No 1 Skagit Past Accepting new patients

Locations

2511 M Ave
Ste D
Anacortes, WA 98221
Phone (360) 293-0308

328 S Stillaguamish Ave
Arlington, WA 98223
Phone (360) 435-2133

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

1415 E Kincaid St
Mount Vernon, WA 98274
Phone (360) 416-5750

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

Interoperability endpoints

  • Direct secure messaging: klohavanichbutr14857@skagit.direct-ci.com

Organizations & group practices 4

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 9

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": "1150416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1457740800000",
    "number": "1306880638",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 E. KINCAID ST.",
            "address_2": "ATTN: CREDENTIALING",
            "city": "MOUNT VERNON",
            "state": "WA",
            "postal_code": "982744127",
            "telephone_number": "360-428-2500",
            "fax_number": "360-428-6485"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "307 S 13TH ST",
            "address_2": "SUITE 300",
            "city": "MOUNT VERNON",
            "state": "WA",
            "postal_code": "982744100",
            "telephone_number": "360-336-9757",
            "fax_number": "360-814-5237"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOHAVANICHBUTR",
        "first_name": "KAMOL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-16",
        "last_updated": "2016-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "WA",
            "license": "MD00036595",
            "primary": true
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "WA",
            "license": "MD00036595",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8417024",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mount Vernon, WA

Sources for this page

Verify at the official NPI Registry.