Individual provider Active NPI

Robert A. Brezak, MD

  • Diagnostic Radiology Physician
  • Tacoma, WA
National Provider Identifier
1386818516
Registry record updated Aug 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
MD60367833 Issued in WA
Practice address
1304 Fawcett Ave Ste 100
Tacoma, WA 98402-1900
Phone
(253) 761-4200
NPI assigned
Apr 18, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 29, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Body Imaging Physician 2085B0100X 60367833 WA
Diagnostic Radiology Physician 2085R0202X MD205146 OR
Diagnostic Radiology Physician 2085R0202X MD60367833 WA Primary

Addresses

Primary practice location

1304 Fawcett Ave Ste 100
Tacoma, WA 98402-1900

Mailing address

1304 Fawcett Ave Ste 100
Tacoma, WA 98402-1900
Phone (253) 761-4200

Other practice location 1

19020 33rd Ave W
Suite 210
Lynnwood, WA 98036-4746
Phone (425) 563-1500

Other practice location 2

930 SW Abbey St
Newport, OR 97365-4820
Phone (541) 265-2244

Other identifiers 6

IdentifierTypeStateIssuer
340866OtherWALNI PROVIDER ID
2029135MedicaidWA
340865OtherWALNI PROVIDER ID
1386818516MedicaidWA
340864OtherWALNI PROVIDER ID
340867OtherWALNI PROVIDER ID

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address rbrezakcontractstaff216202@samhealth.direct-ci.com

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
I20140729000625 WA Practitioner - Diagnostic Radiology 7416173422 Reassigns benefits to 7 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
New York Medical College, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Tra-Minw P SGroup PAC ID 2163316167, 152 clinicians
Union Avenue Open MRI LLCGroup PAC ID 5597652917, 44 clinicians

Practice addresses (Care Compare)

6910 160TH St SW
Edmonds, WA 98026-4537
Phone (253) 841-4353

Hospital & facility affiliations

  • Tacoma General Allenmore Hospital Hospital, Tacoma, WA, CCN 500129
  • Multicare Good Samaritan Hospital Hospital, Puyallup, WA, CCN 500079
  • St Joseph Medical Center Hospital, Tacoma, WA, CCN 500108
  • St Anthony Hospital Hospital, Gig Harbor, WA, CCN 500151
  • St Clare Hospital Hospital, Lakewood, WA, CCN 500021

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
60367833WAMDBody Imaging Physician
MD205146ORMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Medical Imaging Northwest - Good Samaritan Hospital Imaging Alliance CurrentSince Apr 1, 2023 Accepting new patients
Radia Imaging Center Holdings LLC Diagnostic Radiology CurrentSince Jan 1, 2019 Accepting new patients
Tra Medical Imaging Centers LLC CurrentSince Dec 1, 2025 Accepting new patients
Tra-Minw P S CurrentSince Apr 1, 2023 Accepting new patients
Swedish Radia Imaging Center at Edmonds LLC Diagnostic Radiology CurrentSince Jul 28, 2015 Accepting new patients
Evergreen Radia LLC Diagnostic Radiology CurrentSince Jul 28, 2015 Accepting new patients
Union Avenue Open MRI LLC CurrentSince Apr 1, 2023 Accepting new patients

Locations

21700 Highway 99
Edmonds, WA 98026
Phone (425) 640-4949

13020 Meridian Ave S
Everett, WA 98208
Phone (425) 357-3700

34515 9th Ave S
Federal Way, WA 98003
Phone (253) 835-8100

11521 NE 128th St
Ste 200
Kirkland, WA 98034
Phone (425) 952-6100

19020 33rd Ave W
Ste 210
Lynnwood, WA 98036
Phone 42556315001

1025 153rd St SE
Ste 200
Mill Creek, WA 98012
Phone (425) 338-4000

3417 Ensign Rd NE
Olympia, WA 98506
Phone (360) 493-4600

222 15th Ave SE
Puyallup, WA 98372

18100 NE Union Hill Rd
Redmond, WA 98052
Phone (425) 498-2020

1229 Madison St
Ste 900
Seattle, WA 98104
Phone (206) 292-6233

1221 Madison St
Ste 150
Seattle, WA 98104
Phone (206) 215-6433

500 17th Ave
Seattle, WA 98122
Phone (206) 320-2111

3402 S 18th St
Tacoma, WA 98405
Phone (253) 383-1099

1304 Fawcett Ave
Ste 100
Tacoma, WA 98402
Phone (253) 680-3372

2502 S Union Ave
Tacoma, WA 98405
Phone (253) 759-5900

4816 NE Thurston Way
Ste A
Vancouver, WA 98662
Phone (360) 254-4914

Interoperability endpoints

  • FHIR API: https://app.meldrx.com/api/fhir/ei-trami

Organizations & group practices 7

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 8

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": "1208476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724889600000",
    "number": "1386818516",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1304 FAWCETT AVE STE 100",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984021900",
            "telephone_number": "253-761-4200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1304 FAWCETT AVE STE 100",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984021900",
            "telephone_number": "253-761-4200"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "19020 33rd Ave W",
            "address_2": "Suite 210",
            "address_purpose": "LOCATION",
            "city": "Lynnwood",
            "state": "WA",
            "postal_code": "980364746",
            "country_code": "US",
            "telephone_number": "425-563-1500",
            "fax_number": "425-563-1501",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "930 SW Abbey St",
            "address_purpose": "LOCATION",
            "city": "Newport",
            "state": "OR",
            "postal_code": "973654820",
            "country_code": "US",
            "telephone_number": "541-265-2244",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BREZAK",
        "first_name": "ROBERT",
        "middle_name": "A.",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-04-18",
        "last_updated": "2024-08-29",
        "certification_date": "2024-08-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085B0100X",
            "taxonomy_group": "",
            "desc": "Radiology, Body Imaging",
            "state": "WA",
            "license": "60367833",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "OR",
            "license": "MD205146",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "WA",
            "license": "MD60367833",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LNI PROVIDER ID",
            "identifier": "340866",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2029135",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LNI PROVIDER ID",
            "identifier": "340865",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1386818516",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LNI PROVIDER ID",
            "identifier": "340864",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LNI PROVIDER ID",
            "identifier": "340867",
            "state": "WA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rbrezakcontractstaff216202@samhealth.direct-ci.com",
            "affiliation": "N",
            "address_1": "930 SW Abbey St",
            "city": "Newport",
            "state": "OR",
            "country_code": "US",
            "postal_code": "973654820",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Tacoma, WA

Sources for this page

Verify at the official NPI Registry.