Lake Washington Private Medicine Inc

Primary specialty

Pain Medicine PhysicianTaxonomy code 208VP0000X

License

602289671 Issued in WA

Legal business name

LAKE WASHINGTON PRIVATE MEDICINE INC

Doing business as

Lake Washington Pain Management

Practice address

13122 120TH Ave NE
Kirkland, WA 98034-3014

Phone

(425) 678-8534

Fax

(425) 678-8564

NPI assigned

Jan 16, 2007

Last updated

Jan 1, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. David Keith Naibert, MDNPI 1437169356

Title

Owner

Phone

(425) 678-8534

Specialties & licenses 1

Addresses

Other names 1

• Lake Washington Pain Management Doing business as

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• Advanced Pain Care PS

  • Physician Assistant
  • Olympia, WA
  • NPI 1114410495
  NPPES parent name

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• David Keith Naibert Jr., M.D.

  • Pain Medicine Physician
  • Kirkland, WA
  • NPI 1437169356
  Medicare reassignment NPD Authorized official
• Melissa Ann Barclay, ARNP

  • Nurse Practitioner
  • Edmonds, WA
  • NPI 1053943993
  Medicare reassignment NPD
• Dylan Miller, DNP

  • Nurse Practitioner
  • Seattle, WA
  • NPI 1275377715
  Medicare reassignment NPD
• David Wayne Overton, PA-C

  • Physician Assistant
  • Lacey, WA
  • NPI 1851307003
  Medicare reassignment
• Grace Chia-Hua Chen, PA-C

  • Physician Assistant
  • Mountlake Terrace, WA
  • NPI 1639176902
  NPD (past)
• Rajni K Jutla, MD

  • Pain Medicine (Anesthesiology) Physician
  • Edmonds, WA
  • NPI 1467564484
  NPD (past)
• Joanna Lynn Katz, NP

  • Family Nurse Practitioner
  • Edmonds, WA
  • NPI 1306968490
  NPD (past)
• Geoffrey Louis Tyson, M.D.

  • Pain Medicine (Anesthesiology) Physician
  • Mountlake Terrace, WA
  • NPI 1679610778
  NPD (past)
• Craig Frank Whitfield, PA-C

  • Medical Physician Assistant
  • Mountlake Terrace, WA
  • NPI 1689714693
  NPD (past)

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

{
    "created_epoch": "1168905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704067200000",
    "number": "1427109271",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13122 120TH AVE NE",
            "city": "KIRKLAND",
            "state": "WA",
            "postal_code": "980343014",
            "telephone_number": "425-678-8534",
            "fax_number": "425-678-8564"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13122 120TH AVE NE",
            "city": "KIRKLAND",
            "state": "WA",
            "postal_code": "980343014",
            "telephone_number": "425-678-8534",
            "fax_number": "425-678-8564"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE WASHINGTON PRIVATE MEDICINE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-16",
        "last_updated": "2024-01-01",
        "certification_date": "2024-01-01",
        "status": "A",
        "authorized_official_last_name": "NAIBERT",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "KEITH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "425-678-8534",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208VP0000X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Pain Medicine",
            "state": "WA",
            "license": "602289671",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lake Washington Pain Management",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Lake Washington Endodontics LLC
• Lake Washington Family Chiropractic PLLC
• Lake Washington Family Chiropractic, PLLC
• Lake Washington Midwives
• Lake Washington Physical Therapy LLC
• Lake Washington Technical College Dental Clinic
• Jennifer Lake
• Brianna Deshai Lakes, PT, DPT
• Lakeshore Clinic PLLC
• Lakeside Recovery Centers Inc (Lakeside Milam Recovery Centers)

• Pain Medicine Physician in Kirkland, WA
• Providers in Kirkland, WA by specialty
• Pain Medicine Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.