Organization Active NPI

Rapha Clinics, Inc

  • Podiatrist
  • Shoreline, WA
National Provider Identifier
1366749095
Registry record updated Feb 15, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
PO00000700 Issued in WA
Legal business name
RAPHA CLINICS, INC
Practice address
1130 N 185TH St Ste 202
Shoreline, WA 98133-4011
Phone
(206) 542-1000
Fax
(206) 542-5353
NPI assigned
Feb 15, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 15, 2011

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

Authorized official

Name
John Y Joo, DPM
Title
Physician/Owner
Phone
(206) 542-1000

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
PodiatristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 213E00000X PO00000700 WA Primary
Primary Podiatric Medicine PodiatristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 213EP1101X PO00000700 WA
Foot & Ankle Surgery PodiatristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 213ES0103X PO00000700 WA

Addresses

Primary practice location

1130 N 185TH St Ste 202
Shoreline, WA 98133-4011

Mailing address

1130 N 185TH St Ste 202
Shoreline, WA 98133-4011
Phone (206) 542-1000

Other identifiers 5

IdentifierTypeStateIssuer
GAB36982OtherWAMEDICARE PTAN
GAB36984OtherWAMEDICARE PTAN
115773MedicaidWA
GAB36981OtherMEDICARE PTAN
GAB36983OtherWAMEDICARE PTAN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040408001104 WA Part B Supplier - Clinic/Group Practice 2264426790 Receives reassigned benefits from 2 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Cle Elum, WA; Shoreline, WA

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

8737 South Tacoma Way
Lakewood, WA 98499
Phone (206) 542-5323

1130 N 185th St
Ste 202
Shoreline, WA 98133
Phone (206) 542-1000

8815 South Tacoma Way
Tacoma, WA 98499
Phone (253) 344-0136

Practitioners & affiliated clinicians

Practitioners 1

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": "1297728000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1297728000000",
    "number": "1366749095",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1130 N 185TH ST STE 202",
            "city": "SHORELINE",
            "state": "WA",
            "postal_code": "981334011",
            "telephone_number": "206-542-1000",
            "fax_number": "206-542-5353"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1130 N 185TH ST STE 202",
            "city": "SHORELINE",
            "state": "WA",
            "postal_code": "981334011",
            "telephone_number": "206-542-1000",
            "fax_number": "206-542-5353"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RAPHA CLINICS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-02-15",
        "last_updated": "2011-02-15",
        "status": "A",
        "authorized_official_last_name": "JOO",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "Y",
        "authorized_official_title_or_position": "PHYSICIAN/OWNER",
        "authorized_official_telephone_number": "206-542-1000",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Podiatrist",
            "state": "WA",
            "license": "PO00000700",
            "primary": true
        },
        {
            "code": "213EP1101X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Podiatrist, Primary Podiatric Medicine",
            "state": "WA",
            "license": "PO00000700",
            "primary": false
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "WA",
            "license": "PO00000700",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "GAB36982",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "GAB36984",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "115773",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "GAB36981",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "GAB36983",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Shoreline, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.