Active NPI
Miracle Israel
- Nurse Practitioner
- Lynnwood, WA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- AP61081985
- Practice address
- 19116 33Rd Ave W
Lynnwood, WA 98036-4706 - Phone
- (425) 712-7900
- Fax
- (425) 712-7905
- NPI assigned
- Feb 25, 2020
- Last updated
- Mar 30, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | AP61081985 | WA | Primary |
| Registered Nurse | 163W00000X | RN60490415 | WA |
Addresses
Primary practice location
19116 33Rd Ave W
Lynnwood, WA 98036-4706
Mailing address
19116 33Rd Ave W
Lynnwood, WA 98036-4706
Phone (425) 712-7900
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: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Nurse Practitioner
- Education
- University of Washington School of Medicine, 2020
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
19116 33Rd Ave W
Lynnwood, WA 98036-4706
Phone (425) 712-7900
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN60490415 | WA | MD | Registered Nurse |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Virginia Mason Medical Center | Current | Accepting new patients | |
| Virginia Mason Medical Center | Current | Accepting new patients | |
| Virginia Mason Medical Center | Current | Accepting new patients | |
| Virginia Mason Medical Center | Past | Accepting new patients |
Locations
380 Winslow Way E
Bainbridge Island, WA 98110
Phone (206) 842-5632
19116 33rd Ave W
Lynnwood, WA 98036
Phone (425) 712-7900
1100 9th Ave
Seattle, WA 98101
Phone (206) 223-6980
4575 Sand Point Way NE
Ste 108
Seattle, WA 98105
Phone (206) 525-8000
925 Seneca St
Seattle, WA 98101
Phone (206) 341-0860
Interoperability endpoints
- https://fhir-myrecord.cerner.com/r4/66ad9a50-d7f7-4c21-b933-2ba90047388e/
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- General Acute Care Hospital
- Seattle, WA
- NPI 1801851258
-
dba St Joseph Medical Center
- Interventional Cardiology Physician
- Tacoma, WA
- NPI 1821711953
-
dba Virginia Mason Medical Center-Family Practice
- Family Medicine Physician
- Seattle, WA
- NPI 1922162809
-
dba Virginia Mason Medical Center-Gastroenterology
- Gastroenterology Physician
- Seattle, WA
- NPI 1003970989
Hospital & facility affiliations 2
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
dba EvergreenHealth Home Care
- Home Health Agency
- Kirkland, WA
- NPI 1588662761
-
- General Acute Care Hospital
- Seattle, WA
- NPI 1801851258
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1582588800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1617062400000",
"number": "1326672676",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "19116 33RD AVE W",
"city": "LYNNWOOD",
"state": "WA",
"postal_code": "980364706",
"telephone_number": "425-712-7900",
"fax_number": "425-712-7905"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "19116 33RD AVE W",
"city": "LYNNWOOD",
"state": "WA",
"postal_code": "980364706",
"telephone_number": "425-712-7900",
"fax_number": "425-712-7905"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ISRAEL",
"first_name": "MIRACLE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-02-25",
"last_updated": "2021-03-30",
"certification_date": "2021-03-30",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "WA",
"license": "AP61081985",
"primary": true
},
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "WA",
"license": "RN60490415",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Lynnwood, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- 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.