Indrawan Husodo, M.D.

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

License

MD00028376 Issued in WA

Practice address

990 Sylvan Way
Bremerton, WA 98310-2851

Phone

(360) 479-3657

Fax

(360) 373-7616

NPI assigned

Jul 8, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 8

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

Specialty

Anesthesiology

Education

Other, 1979

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Olympic Anesthesia Services, IncGroup PAC ID 4587551064, 38 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• St Michael Medical Center Hospital, Silverdale, WA, CCN 500039

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Olympic Anesthesia Services, Inc

  • Anesthesiology Physician
  • Bremerton, WA
  • NPI 1275586125
  Medicare reassignment Care Compare group NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Commonspirit Washington Community Care

  • General Acute Care Hospital
  • Silverdale, WA
  • NPI 1518912609
  Care Compare affiliation

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

{
    "created_epoch": "1120780800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1232496000000",
    "number": "1376541847",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "990 SYLVAN WAY",
            "city": "BREMERTON",
            "state": "WA",
            "postal_code": "983102851",
            "telephone_number": "360-479-3657",
            "fax_number": "360-373-7616"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "990 SYLVAN WAY",
            "city": "BREMERTON",
            "state": "WA",
            "postal_code": "983102851",
            "telephone_number": "360-479-3657",
            "fax_number": "360-373-7616"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HUSODO",
        "first_name": "INDRAWAN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-08",
        "last_updated": "2009-01-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "WA",
            "license": "MD00028376",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LABOR AND INDUSTRIES",
            "identifier": "72669",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE BLUE SHIELD",
            "identifier": "HU0090",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8132292",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KPS",
            "identifier": "91084721521",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP HEALTH CORP",
            "identifier": "06487001",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREMERA BLUE CROSS",
            "identifier": "910847215",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDCIARE",
            "identifier": "050042796",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VICTIMS OF CRIME",
            "identifier": "8933482",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michael H Huntley, DDS,PLLC
• Elizabeth Ann Hupp, BS/MSPA CCC
• Jillian Loretta Hurd, PA-C
• Brittany Sue Hurst, FNP-C
• Monica Hurst, PA-C
• Amanda L Huson
• Chad H. Hutchinson, M.D.
• Kathleen Erin Hutchinson, PT DPT
• Matthew Laurence Kelly Hutchinson
• Mary R Hutton Eyer, ARNP

• Anesthesiology Physician in Bremerton, WA
• Providers in Bremerton, WA by specialty
• Anesthesiology Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.