NPIMap

Individual provider Active NPI

Elvira V Kadyrova, MD

  • Family Medicine Physician
  • Lacey, WA
National Provider Identifier
1386932580
Registry record updated Feb 15, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD60400832 Issued in WA
Practice address
1450 Northwest LN SE Ste a
Lacey, WA 98503-6908
Phone
(360) 491-4460
Fax
(360) 491-3090
NPI assigned
Jul 21, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 15, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MD60400832 WA Primary

Addresses

Primary practice location

1450 Northwest LN SE Ste a
Lacey, WA 98503-6908

Mailing address

PO Box 3360
Portland, OR 97208-3360

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address ekadyronva92254@wm.providencedirect.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160105000580 WA Practitioner - Family Practice 7416172523 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Providence Health and Services WashingtonGroup PAC ID 6709782600, 480 clinicians
Select Outpatient Services IncGroup PAC ID 4082868815, 750 clinicians
Select Rehabilitation, LLCGroup PAC ID 9032020490, 1,935 clinicians

Practice addresses (Care Compare)

1450 Northwest LN SE
Suite a
Lacey, WA 98503-6908
Phone (360) 491-4460

2600 Compass Rd
Glenview, IL 60026-8001

525 Lilly Rd NE
Olympia, WA 98506-5101

Hospital & facility affiliations

  • Providence at Home With Compassus, Puget Sound South Home health agency, Lacey, WA, CCN 507004
  • Assured Home Health and Hospice Home health agency, Centralia, WA, CCN 507042
  • Careage Home Health Home health agency, Dupont, WA, CCN 507129
  • Providence St Peter Hospital Hospital, Olympia, WA, CCN 500024
  • Providence Centralia Hospital Hospital, Centralia, WA, CCN 500019
  • Capital Medical Center Hospital, Olympia, WA, CCN 500139
  • Mason General Hospital & Family of Clinics Hospital, Shelton, WA, CCN 501336
  • St Joseph Medical Center Hospital, Tacoma, WA, CCN 500108
  • Panorama City Conv & Rehab Ctr Nursing home, Lacey, WA, CCN 505059

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD60400832WAMDFamily Medicine Physician

Interoperability endpoints

  • Direct secure messaging: ekadyronva92254@wm.providencedirect.org

Organizations & group practices 2

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 16

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

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1311206400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1676419200000",
    "number": "1386932580",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3360",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972083360"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1450 NORTHWEST LN SE STE A",
            "city": "LACEY",
            "state": "WA",
            "postal_code": "985036908",
            "telephone_number": "360-491-4460",
            "fax_number": "360-491-3090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KADYROVA",
        "first_name": "ELVIRA",
        "middle_name": "V",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-07-21",
        "last_updated": "2023-02-15",
        "certification_date": "2023-02-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "MD60400832",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ekadyronva92254@wm.providencedirect.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "525 Lilly Rd NE Ste 250",
            "address_2": "PMG SW WA East Olympia Fam Med",
            "city": "Olympia",
            "state": "WA",
            "country_code": "US",
            "postal_code": "985065101",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Lacey, WA

Sources for this page

Verify at the official NPI Registry.