Individual provider Active NPI

Anastasia Bakulina, MD

  • Internal Medicine Physician
  • Everett, WA
National Provider Identifier
1407464993
Registry record updated Jul 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD.MD.61409813 Issued in WA
Practice address
1424 Broadway
Everett, WA 98201
Phone
(425) 789-2000
Fax
(425) 789-2096
NPI assigned
Jul 21, 2020
Last updated
Jul 13, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2023

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 MD.MD.61409813 WA Primary

Addresses

Primary practice location

1424 Broadway
Everett, WA 98201

Mailing address

1424 Broadway
Everett, WA 98201-1720
Phone (425) 789-2000

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
I20231107003450 WA Practitioner - Internal Medicine 5496166472 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Select Outpatient Services IncGroup PAC ID 4082868815, 750 clinicians
Select Rehabilitation, LLCGroup PAC ID 9032020490, 1,935 clinicians

Practice addresses (Care Compare)

1019 112TH St SW
Everett, WA 98204-4875
Phone (425) 551-6200

1424 Broadway
Everett, WA 98201-1720
Phone (425) 789-2000

2600 Compass Rd
Glenview, IL 60026-8001

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD.MD.61409813WAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Community Health Center of Snohomish County CurrentSince Oct 2, 2023 Accepting new patients
Community Health Center of Snohomish County CurrentSince Oct 2, 2023 Accepting new patients

Locations

326 S Stillaguamish Ave
Arlington, WA 98223
Phone (360) 435-2144

23320 Highway 99
Edmonds, WA 98026
Phone (425) 640-5500

1019 112th St SW
Everett, WA 98204
Phone (425) 551-6001

1424 Broadway
Everett, WA 98201
Phone (425) 551-1000

4201 Rucker Ave
Everett, WA 98203
Phone (425) 382-4000

8609 Evergreen Way
Everett, WA 98208
Phone (425) 551-6200

930 N Broadway
Everett, WA 98201
Phone (425) 317-0300

4111 194th St SW
Lynnwood, WA 98036
Phone (425) 835-5200

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

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": "1595289600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689206400000",
    "number": "1407464993",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1424 BROADWAY",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982011720",
            "telephone_number": "425-789-2000",
            "fax_number": "425-789-2096"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1424 BROADWAY",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "98201",
            "telephone_number": "425-789-2000",
            "fax_number": "425-789-2096"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAKULINA",
        "first_name": "ANASTASIA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-07-21",
        "last_updated": "2023-07-13",
        "certification_date": "2023-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WA",
            "license": "MD.MD.61409813",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Everett, WA

Sources for this page

Verify at the official NPI Registry.