NPIMap

Individual provider Active NPI

Sayed Amirhossein Khademi, MD

  • Internal Medicine Physician
  • Everett, WA
National Provider Identifier
1407271547
Registry record updated Jun 16, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD60598928 Issued in WA
Practice address
12800 Bothell Everett Hwy
Everett, WA 98208-6642
Phone
(425) 316-5130
Fax
(425) 316-5131
NPI assigned
Feb 26, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD60598928 WA Primary

Addresses

Primary practice location

12800 Bothell Everett Hwy
Everett, WA 98208-6642

Mailing address

PO Box 3360
Portland, OR 97208-3360
Phone (866) 747-2455

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address skhademi668527@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
I20160809001741 WA Practitioner - Internal Medicine 8224322581 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

12800 Bothell Everett Hwy
Everett, WA 98208-6644

4112 Harbour Pointe Blvd SW
Suite 100
Mukilteo, WA 98275-5457
Phone (425) 347-6330

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD60598928WAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Health & Services- Washington CurrentSince Sep 12, 2016 Accepting new patients
Providence Health & Services-Washington CurrentSince Sep 12, 2016 Accepting new patients
Providence Health & Services - Washington Past Accepting new patients

Locations

1321 Colby Ave
Ofc
Everett, WA 98201
Phone (425) 261-4076

12800 Bothell Everett Hwy
Everett, WA 98208
Phone (425) 316-5060

4112 Harbour Pointe Blvd SW
Ste 100
Mukilteo, WA 98275
Phone (425) 347-6330

Interoperability endpoints

  • Direct secure messaging: skhademi668527@wm.providencedirect.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 7

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": "1393372800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623801600000",
    "number": "1407271547",
    "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",
            "telephone_number": "866-747-2455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12800 BOTHELL EVERETT HWY",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982086642",
            "telephone_number": "425-316-5130",
            "fax_number": "425-316-5131"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHADEMI",
        "first_name": "SAYED AMIRHOSSEIN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-02-26",
        "last_updated": "2021-06-16",
        "certification_date": "2021-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WA",
            "license": "MD60598928",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "skhademi668527@wm.providencedirect.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "12800 Bothell Everett Hwy",
            "city": "Everett",
            "state": "WA",
            "country_code": "US",
            "postal_code": "982086642",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Everett, WA

Sources for this page

Verify at the official NPI Registry.