Individual provider Active NPI

Sumathy T Pathy, M.D.

  • Family Medicine Physician
  • Bellevue, WA
National Provider Identifier
1346273158
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD00042001 Issued in WA
Practice address
11420 NE 20TH St Ste a
Bellevue, WA 98004-3007
Phone
(452) 688-5777
Fax
(425) 369-1435
NPI assigned
Jul 8, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MD00042001 WA Primary

Addresses

Primary practice location

11420 NE 20TH St Ste a
Bellevue, WA 98004-3007

Mailing address

11420 Ne20Th Street
Bellevue, WA 98004-1501
Phone (425) 688-5470

Other identifiers 2

IdentifierTypeStateIssuer
1117753MedicaidWA
MD00042001OtherWAMD LICENSE

Other names 1

  • Sumathy Thiyagarajah 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
I20050404000985 WA Practitioner - Family Practice 3971597139 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

11420 NE 20TH St
Suite a
Bellevue, WA 98004-3007
Phone (425) 646-7800

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD00042001WAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Family Medicine Center, PLLC Family Medicine CurrentSince Aug 1, 2003 Accepting new patients
Overlake Medical Clinics LLC Past Accepting new patients
Fort Wayne Medical Education Program Family Medicine PastSince Sep 1, 2024 Accepting new patients
Overlake Medical Clinics, LLC Past Accepting new patients

Locations

11420 NE 20th St
#A
Bellevue, WA 98004
Phone (425) 646-7800

1515 116th Ave NE
Ste 107
Bellevue, WA 98004
Phone (425) 646-7800

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/15476/brand/1/csg/1/fhir/r4
  • Direct secure messaging: sumathy.pathy.1@15476.direct.athenahealth.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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152316800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1346273158",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11420 NE20TH STREET",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980041501",
            "telephone_number": "425-688-5470",
            "fax_number": "425-688-5605"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11420 NE 20TH ST STE A",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980043007",
            "telephone_number": "452-688-5777",
            "fax_number": "425-369-1435"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PATHY",
        "first_name": "SUMATHY",
        "middle_name": "T",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-08",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "MD00042001",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1117753",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MD LICENSE",
            "identifier": "MD00042001",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SUMATHY",
            "last_name": "THIYAGARAJAH",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Bellevue, WA

Sources for this page

Verify at the official NPI Registry.