NPIMap

Organization Active NPI

Eastside Vascular LLP

  • Vascular Surgery Physician
  • Bellevue, WA
National Provider Identifier
1356471833
Registry record updated Nov 3, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
Legal business name
EASTSIDE VASCULAR LLP
Practice address
1135 116TH Ave NE Ste 220
Bellevue, WA 98004-4623
Phone
(425) 450-7007
Fax
(425) 450-0026
NPI assigned
Mar 6, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 3, 2009

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

Authorized official

Name
Dudley Moorhead II, MEDICAL DOCTORNPI 1306864673
Title
Partner
Phone
(425) 450-7007

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2086S0129X Primary

Addresses

Primary practice location

1135 116TH Ave NE Ste 220
Bellevue, WA 98004-4623

Mailing address

1135 116TH Ave NE Ste 220
Bellevue, WA 98004-4623
Phone (425) 450-7007

Other identifiers 3

IdentifierTypeStateIssuer
CB3636OtherRAILROAD MEDICARE
1371004MedicaidWA
1098326MedicaidWA

National Provider Directory

National Provider Directory

Locations

1135 116th Ave NE
#220
Bellevue, WA 98004
Phone (206) 450-7007

1135 116th Ave NE
Ste 220
Bellevue, WA 98004
Phone (425) 450-7007

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1173139200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1257206400000",
    "number": "1356471833",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1135 116TH AVE NE STE 220",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980044623",
            "telephone_number": "425-450-7007",
            "fax_number": "425-450-0026"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1135 116TH AVE NE STE 220",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980044623",
            "telephone_number": "425-450-7007",
            "fax_number": "425-450-0026"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTSIDE VASCULAR LLP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-06",
        "last_updated": "2009-11-03",
        "status": "A",
        "authorized_official_last_name": "MOORHEAD",
        "authorized_official_first_name": "DUDLEY",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "425-450-7007",
        "authorized_official_name_suffix": "II",
        "authorized_official_credential": "MEDICAL DOCTOR"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery, Vascular Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CB3636",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1371004",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1098326",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bellevue, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.