Individual provider Active NPI

Carly Villarreal, MD

  • Family Medicine Physician
  • Spokane, WA
National Provider Identifier
1396206884
Registry record updated Mar 19, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
61334651 Issued in WA
Practice address
5901 N Lidgerwood St Ste 126
Spokane, WA 99208-1122
Phone
(509) 434-1990
NPI assigned
Mar 27, 2019
Last updated
Mar 19, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 19, 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 61334651 WA Primary

Addresses

Primary practice location

5901 N Lidgerwood St Ste 126
Spokane, WA 99208-1122

Mailing address

611 N Iron Bridge Way
Spokane, WA 99202-4932

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
I20230215003174 WA Practitioner - Family Practice 1951773191 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Loma Linda University School of Medicine, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

5901 N Lidgerwood St
126 Spokane Urgent Care
Spokane, WA 99208-1122
Phone (509) 434-1990

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
61334651WAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Community Health Association of Spokane CurrentSince Mar 7, 2023 Accepting new patients
Community Health Association of Spokane Current Accepting new patients
Community Health Association of Spokane CurrentSince Mar 7, 2023 Accepting new patients
Community Health Association of Spokane Family Medicine Past Accepting new patients
Community Health Association of Spokane Past Accepting new patients

Locations

1720 2nd St
Cheney, WA 99004
Phone (207) 865-8002

1001 W 2nd Ave
Spokane, WA 99201
Phone (509) 835-1205

3919 N Maple St
Spokane, WA 99205
Phone (509) 326-6900

5620 S Regal St
Ste 11
Spokane, WA 99223
Phone (509) 340-1590

5901 N Lidgerwood St
Ste 126
Spokane, WA 99208
Phone (509) 434-1990

5921 N Market St
Spokane, WA 99208
Phone (509) 487-1604

611 N Iron Bridge Way
Spokane, WA 99202

914 W Carlisle Ave
Spokane, WA 99205
Phone (509) 325-0393

1502 N Vercler Rd
Spokane Valley, WA 99216
Phone (509) 444-8204

Interoperability endpoints

  • Direct secure messaging: carly.villarreal.1@11411.direct.athenahealth.com

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1553644800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1679184000000",
    "number": "1396206884",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "611 N IRON BRIDGE WAY",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992024932"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5901 N LIDGERWOOD ST STE 126",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992081122",
            "telephone_number": "509-434-1990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VILLARREAL",
        "first_name": "CARLY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-03-27",
        "last_updated": "2023-03-19",
        "certification_date": "2023-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "61334651",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Spokane, WA

Sources for this page

Verify at the official NPI Registry.