Individual provider Active NPI

Chinda Roach, MD

  • Family Medicine Physician
  • Everett, WA
National Provider Identifier
1457362196
Registry record updated Jul 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD00038223 Issued in WA
Practice address
8609 Evergreen Way
Everett, WA 98208-2619
Phone
(425) 347-7797
Fax
(425) 353-0987
NPI assigned
Aug 10, 2006
Last updated
Jul 9, 2007By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2007

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 MD00038223 WA Primary

Addresses

Primary practice location

8609 Evergreen Way
Everett, WA 98208-2619

Mailing address

8609 Evergreen Way
Everett, WA 98208-2619
Phone (425) 347-7797

Other identifiers 3

IdentifierTypeStateIssuer
152832OtherWAWORK COMP
8252165MedicaidWA
A003OtherWATRICARE

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
I20071011000467 WA Practitioner - Family Practice 2860588530 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

3815 S Othello St
FL 2
Seattle, WA 98118-3510
Phone (206) 788-3500

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD00038223WAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
International Community Health Services Family Medicine CurrentSince Jun 1, 2007 Accepting new patients
International Community Health Services CurrentSince Jun 1, 2007 Accepting new patients
Swedish Health Services Past Accepting new patients

Locations

3815 S Othello St
Fl 2
Seattle, WA 98118
Phone (206) 788-3500

720 8th Ave S
Seattle, WA 98104
Phone (206) 788-3757

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.

NPI Registry JSON

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

{
    "created_epoch": "1155168000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1457362196",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8609 EVERGREEN WAY",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982082619",
            "telephone_number": "425-347-7797",
            "fax_number": "425-353-0987"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8609 EVERGREEN WAY",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982082619",
            "telephone_number": "425-347-7797",
            "fax_number": "425-353-0987"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROACH",
        "first_name": "CHINDA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-10",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "MD00038223",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WORK COMP",
            "identifier": "152832",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8252165",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "A003",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Everett, WA

Sources for this page

Verify at the official NPI Registry.