NPIMap

Organization Active NPI

International Community Health Services

  • Federally Qualified Health Center (FQHC)
  • Seattle, WA
National Provider Identifier
1376659151
Registry record updated Mar 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
INTERNATIONAL COMMUNITY HEALTH SERVICES
Practice address
720 8TH Ave S
Seattle, WA 98104-3032
Phone
(206) 788-3700
Fax
(206) 788-3706
NPI assigned
Aug 22, 2006
Last updated
Mar 29, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 29, 2021

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

Authorized official

Name
Ms. Hermes Shahbazian
Title
Cfo
Phone
(206) 788-3618

Specialties & licenses 13

Specialty (taxonomy)CodeLicenseStatePrimary
PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103T00000X
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X
AcupuncturistGroup: 193200000X MULTI-SPECIALTY GROUP 171100000X
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X
Foot Surgery PodiatristGroup: 193200000X MULTI-SPECIALTY GROUP 213ES0131X
Case Management Agency 251B00000X
Federally Qualified Health Center (FQHC) 261QF0400X Primary
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X

Addresses

Primary practice location

720 8TH Ave S
Seattle, WA 98104-3032

Mailing address

PO Box 3007
Seattle, WA 98114-3007
Phone (206) 788-3600

Other names 1

  • International District Community Health Center Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031118000233 WA Part A Provider - Federally Qualified Health Center (FQHC) 5799695672 1 other NPI on this enrollment
Practice locations: Seattle, WA
O20040301000204 WA Part B Supplier - Clinic/Group Practice 5799695672 Receives reassigned benefits from 130 practitioners
6 other NPIs on this enrollment
Practice locations: Bellevue, WA; Seattle, WA; Shoreline, WA; Auburn, WA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1376659151. Details of each certification follow.

Federally qualified health center certification: CCN 501806

Legal name
INTERNATIONAL COMMUNITY HEALTH SERVICES
Doing business as
INTERNATIONAL DISTRICT CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 1, 1992
Last certification
Jan 1, 1992
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Sep 4, 1973 in WA
Enrollment address
720 8TH Ave S
Seattle, WA 98104-3032

Other NPIs with the same Medicare PAC ID 6

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 6

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

National Provider Directory

National Provider Directory

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

4238 Auburn Way N
Auburn, WA 98002
Phone (253) 444-0106

1050 140th Ave NE
Ste A
Bellevue, WA 98005
Phone (425) 373-3000

1050 140th Ave NE
Ste Siuta
Bellevue, WA 98005

16300 Mill Creek Blvd
Ste 119
Mill Creek, WA 98012
Phone (206) 399-2487

3815 S Othello St
Ste 2
Seattle, WA 98118

720 8th Ave S
Ste A
Seattle, WA 98104

780 8TH Ave S Ste 100
Seattle, WA 98104

Ownership & related parties

All disclosed owners & managing parties 9

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Mariam Abarientos Individual Corporate DirectorVolunteer Board Director Mar 22, 2017
Hermes Shahbzian Individual Corporate DirectorCfo Nov 19, 2003
W-2 Managing EmployeeCfo Jan 1, 2003
Catherine Johnson Individual Corporate DirectorVolunteer Board Director Jul 25, 2012
Gildas Cheung Individual Corporate DirectorChairman of the Board Jan 28, 2009
John Foz Individual Corporate DirectorVolunteer Board Director Sep 24, 2008
Marvin Eng Individual Corporate DirectorVolunteer Board Director Nov 27, 2019
Chengzhen Dai Individual Corporate DirectorVolunteer Board Director May 27, 2020
Amanda Kimura Individual Corporate DirectorVolunteer Board Director Aug 29, 2018
Kelli Nomura Individual Corporate OfficerCeo Nov 7, 2022
W-2 Managing EmployeeCeo Nov 7, 2022

All facility ownership & control disclosures 4

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Ichs Bellevue Medical and Dental ClinicBellevue, WA, CCN 501971 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 May 1, 2014
May 1, 2014
Ichs Shoreline Medical and Dental ClinicShoreline, WA, CCN 501974 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Sep 15, 2014
Sep 15, 2014
Ichs International District Vision ClinicSeattle, WA, CCN 941034 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Sep 15, 2017
Sep 15, 2017
Ichs Sound Auburn Medical ClinicAuburn, WA, CCN 501074 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 May 1, 2025
May 1, 2025

Owned or controlled facilities with NPI records 4

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 141

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 141

NPI Registry JSON

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

{
    "created_epoch": "1156204800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1616976000000",
    "number": "1376659151",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3007",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981143007",
            "telephone_number": "206-788-3600",
            "fax_number": "206-652-5216"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "720 8TH AVE S",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981043032",
            "telephone_number": "206-788-3700",
            "fax_number": "206-788-3706"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERNATIONAL COMMUNITY HEALTH SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-22",
        "last_updated": "2021-03-29",
        "certification_date": "2021-03-29",
        "status": "A",
        "authorized_official_last_name": "SHAHBAZIAN",
        "authorized_official_first_name": "HERMES",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "206-788-3618",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "171100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Acupuncturist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "213ES0131X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Podiatrist, Foot Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "International District Community Health Center",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "International District Community Health Center",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Seattle, WA

Sources for this page

Verify at the official NPI Registry.