Individual provider Active NPI

Antonio Bedalov, MD

  • Hematology & Oncology Physician
  • Seattle, WA
National Provider Identifier
1407844467
Registry record updated Apr 16, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hematology & Oncology PhysicianTaxonomy code 207RH0003X
License
MD00033620 Issued in WA
Practice address
1101 Madison St
Suite 301
Seattle, WA 98104-1306
Phone
(206) 505-1101
NPI assigned
Oct 12, 2005
Last updated
Apr 16, 2021By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 16, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Hematology & Oncology Physician 207RH0003X MD00033620 WA Primary

Addresses

Primary practice location

1101 Madison St
Suite 301
Seattle, WA 98104-1306

Mailing address

1101 Madison St
Suite 301
Seattle, WA 98104-1306
Phone (206) 505-1101

Other identifiers 1

IdentifierTypeStateIssuer
8241531MedicaidWA

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address abedalov1041115@wm.providencedirect.org Direct

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
I20100507000780 WA Practitioner - Hematology/Oncology 2466580642 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Hematology/Oncology
Education
Other, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The Association of University PhysiciansGroup PAC ID 0446162697, 3,484 clinicians

Practice addresses (Care Compare)

1701 Columbia Rd
Seattle, WA 98195-0001
Phone (206) 598-3100

1959 NE Pacific St
Seattle, WA 98195-0001
Phone (206) 598-4333

825 Eastlake Ave E
Seattle, WA 98109-4405
Phone (206) 288-1000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD00033620WAMDHematology & Oncology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Pacmed Clinics CurrentSince Feb 15, 2010 Accepting new patients
The Association of University Physicians CurrentSince Jan 1, 2001 Accepting new patients
Pacmed Clinics CurrentSince Feb 15, 2010 Accepting new patients

Locations

601 S Carr Rd
Ste 100
Renton, WA 98055
Phone (425) 227-3700

1101 Madison St
Ste 301
Seattle, WA 98104
Phone (206) 505-1101

1959 NE Pacific St
Seattle, WA 98195
Phone (206) 598-4333

Interoperability endpoints

  • Direct secure messaging: abedalov1041115@wm.providencedirect.org
  • Direct secure messaging: abedalov95775@direct.ehre.uwmedicine.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, 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": "1129075200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618531200000",
    "number": "1407844467",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1101 MADISON ST",
            "address_2": "SUITE 301",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981041306",
            "telephone_number": "206-505-1101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 MADISON ST",
            "address_2": "SUITE 301",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981041306",
            "telephone_number": "206-505-1101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BEDALOV",
        "first_name": "ANTONIO",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-10-12",
        "last_updated": "2021-04-16",
        "certification_date": "2021-04-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "WA",
            "license": "MD00033620",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8241531",
            "state": "WA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "abedalov1041115@wm.providencedirect.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1101 Madison St",
            "address_2": "Suite 301",
            "city": "Seattle",
            "state": "WA",
            "country_code": "US",
            "postal_code": "981041306",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Seattle, WA

Sources for this page

Verify at the official NPI Registry.