Individual provider Active NPI

Yinager Agedie Dagnaw, MD

  • Student in an Organized Health Care Education/Training Program
  • Bronx, NY
National Provider Identifier
1356138747
Registry record updated Jun 12, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
4422 3Rd Ave
Bronx, NY 10457-2545
Phone
(718) 960-6202
Fax
(718) 960-3218
NPI assigned
Apr 21, 2025
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 12, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training ProgramGroup: 193400000X SINGLE SPECIALTY GROUP 390200000X NY Primary

Addresses

Primary practice location

4422 3Rd Ave
Bronx, NY 10457-2545

Mailing address

4422 3Rd Ave
Bronx, NY 10457-2545
Phone (718) 960-6202

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
I20250609002994 WA Practitioner - General Practice 0840700829 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
General Practice
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Platinum Peaks Healthcare PCGroup PAC ID 0648784157, 45 clinicians
Pacific Medical Specialty GroupGroup PAC ID 2365838364, 56 clinicians

Practice addresses (Care Compare)

3020 S Union Ave
Tacoma, WA 98409-3317
Phone (253) 844-4327

Hospital & facility affiliations

  • Bethany at Silver Lake Nursing home, Everett, WA, CCN 505403

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MDCE.ML.61687149WAMDGeneral Practice Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Platinum Peaks Healthcare PC CurrentSince Aug 18, 2025 Accepting new patients
Pacific Medical Specialty Group CurrentSince May 1, 2025 Accepting new patients

Locations

3020 S Union Ave
Tacoma, WA 98409
Phone (253) 844-4327

917 Pacific Ave
Ste 600
Tacoma, WA 98402
Phone (253) 232-7495

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 1

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": "1745193600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1781222400000",
    "number": "1356138747",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4422 3RD AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104572545",
            "telephone_number": "718-960-6202",
            "fax_number": "718-960-3218"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4422 3RD AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104572545",
            "telephone_number": "718-960-6202",
            "fax_number": "718-960-3218"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAGNAW",
        "first_name": "YINAGER",
        "middle_name": "AGEDIE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2025-04-21",
        "last_updated": "2026-06-12",
        "certification_date": "2026-06-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NY",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bronx, NY

Sources for this page

Verify at the official NPI Registry.