Individual provider Active NPI

Gavriel David Kohlberg

  • Otolaryngology Physician
  • Seattle, WA
National Provider Identifier
1376867929
Registry record updated Aug 16, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
MD60939547 Issued in WA
Practice address
1959 NE Pacific St
Seattle, WA 98195-3722
Phone
(206) 520-5000
NPI assigned
Mar 24, 2010
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 16, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X MD60939547 WA Primary

Addresses

Primary practice location

1959 NE Pacific St
Seattle, WA 98195-3722

Mailing address

PO Box 50095
Seattle, WA 98145-5095

Other identifiers 1

IdentifierTypeStateIssuer
1376867929MedicaidWA

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
I20190919001072 WA Practitioner - Otolaryngology 2961773593 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
Stanford University School of Medicine, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
The Association of University PhysiciansGroup PAC ID 0446162697, 3,484 clinicians

Practice addresses (Care Compare)

1959 NE Pacific St
Seattle, WA 98195-0001
Phone (206) 598-4333

Hospital & facility affiliations

  • University of Washington Medical Ctr Hospital, Seattle, WA, CCN 500008
  • Harborview Medical Center Hospital, Seattle, WA, CCN 500064

Merit-based Incentive Payment System (MIPS)

Final score
93.85 of 100Reported as apm
Quality
74.6
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD60939547WAMDOtolaryngology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The Association of University Physicians CurrentSince Aug 16, 2019 Accepting new patients
University of Washington Past Accepting new patients
Harborview Medical Center Past Accepting new patients

Locations

1959 NE Pacific St
Seattle, WA 98195
Phone (206) 598-4333

325 9th Ave
Seattle, WA 98104
Phone (206) 731-3000

Interoperability endpoints

  • Direct secure messaging: gkohlberg914257@direct.ehre.uwmedicine.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 2

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": "1269388800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1565913600000",
    "number": "1376867929",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 50095",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981455095"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1959 NE PACIFIC ST",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981953722",
            "telephone_number": "206-520-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOHLBERG",
        "first_name": "GAVRIEL",
        "middle_name": "DAVID",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-03-24",
        "last_updated": "2019-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "WA",
            "license": "MD60939547",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1376867929",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Seattle, WA

Sources for this page

Verify at the official NPI Registry.