Individual provider Active NPI

Anita Elangovan, MD

  • Internal Medicine Physician
  • Bothell, WA
National Provider Identifier
1356316798
Registry record updated May 18, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
0101238955 Issued in VA
Practice address
1909 214TH St SE Ste 300
Bothell, WA 98021-4418
Phone
(425) 412-7200
NPI assigned
Feb 21, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 18, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 0101238955 VA Primary

Addresses

Primary practice location

1909 214TH St SE Ste 300
Bothell, WA 98021-4418

Mailing address

PO Box 7068
Portsmouth, VA 23707-0068
Phone (757) 686-3520

Other practice location 1

208 E Plume St
Suite 213
Norfolk, VA 23510-1757
Phone (757) 233-8252

Other identifiers 2

IdentifierTypeStateIssuer
541951145004OtherVATRICARE
188990OtherVAANTHEM

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address aelangovan1042799@wm.providencedirect.org Direct

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
I20100126000099 WA Practitioner - Internal Medicine 0941223044 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Pacmed ClinicsGroup PAC ID 2466350657, 211 clinicians

Practice addresses (Care Compare)

1101 Madison St
Suite 301
Seattle, WA 98104-3599
Phone (206) 505-1300

1200 12TH Ave S
Seattle, WA 98144-2712
Phone (206) 326-2400

1909 214TH St SE
Suite 300
Bothell, WA 98021-4418
Phone (425) 412-7200

220 15TH Ave SE
Puyallup, WA 98372-3797
Phone (253) 435-3400

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Pacmed Clinics CurrentSince Dec 1, 2009 Accepting new patients
Pacmed Clinics CurrentSince Dec 1, 2009 Accepting new patients
Pacmed Clinics Internal Medicine Current Accepting new patients

Locations

1909 214th St SE
Ste 300
Bothell, WA 98021
Phone (425) 412-6335

19401 40th Ave W
Ste 100
Lynnwood, WA 98036
Phone (425) 309-0954

220 15th Ave SE
Puyallup, WA 98372
Phone (253) 435-3400

1200 12th Ave S
Seattle, WA 98144
Phone (206) 326-2400

1101 Madison St
Ste 301
Seattle, WA 98104
Phone (206) 505-1101

Interoperability endpoints

  • Direct secure messaging: aelangovan1042799@wm.providencedirect.org

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.

Hospital & facility affiliations 4

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": "1140480000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621296000000",
    "number": "1356316798",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7068",
            "city": "PORTSMOUTH",
            "state": "VA",
            "postal_code": "237070068",
            "telephone_number": "757-686-3520",
            "fax_number": "757-686-0230"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1909 214TH ST SE STE 300",
            "city": "BOTHELL",
            "state": "WA",
            "postal_code": "980214418",
            "telephone_number": "425-412-7200"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "208 E Plume St",
            "address_2": "SUITE 213",
            "address_purpose": "LOCATION",
            "city": "Norfolk",
            "state": "VA",
            "postal_code": "235101757",
            "country_code": "US",
            "telephone_number": "757-233-8252",
            "fax_number": "757-233-8905",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ELANGOVAN",
        "first_name": "ANITA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-21",
        "last_updated": "2021-05-18",
        "certification_date": "2021-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "VA",
            "license": "0101238955",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "541951145004",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "188990",
            "state": "VA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "aelangovan1042799@wm.providencedirect.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1909 214th St SE Ste 300",
            "city": "Bothell",
            "state": "WA",
            "country_code": "US",
            "postal_code": "980214418",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Bothell, WA

Sources for this page

Verify at the official NPI Registry.