NPIMap

Organization Active NPI

Cardiorenal Therapeutics of Washington, PLLC

  • Internal Medicine Physician
  • Tacoma, WA
National Provider Identifier
1467054924
Registry record updated Nov 10, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
CARDIORENAL THERAPEUTICS OF WASHINGTON, PLLC
Practice address
1201 Pacific Ave Ste 400
Tacoma, WA 98402-4381
Phone
(253) 300-8447
NPI assigned
Nov 10, 2020
Last updated
Nov 10, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 10, 2020

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

Authorized official

Name
Rehan Shah, MDNPI 1255521332
Title
Owner
Phone
(516) 721-7069

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary
Cardiovascular Disease PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RC0000X
Nephrology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RN0300X

Addresses

Primary practice location

1201 Pacific Ave Ste 400
Tacoma, WA 98402-4381

Mailing address

1201 Pacific Ave Ste 400
Tacoma, WA 98402-4381
Phone (125) 322-8990

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA, ID2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20201215000311 WA Part B Supplier - Clinic/Group Practice 7517379613 Receives reassigned benefits from 28 practitioners
Practice locations: Federal Way, WA
O20230228000884 ID Part B Supplier - Clinic/Group Practice 7517379613 Receives reassigned benefits from 3 practitioners
Practice locations: Coeur D Alene, ID

National Provider Directory

National Provider Directory

Locations

33530 1st Way S
Federal Way, WA 98003
Phone (253) 339-9657

33530 1st Way S
Ste 44
Federal Way, WA 98003
Phone (253) 300-8447

Practitioners & affiliated clinicians

Practitioners 28

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.

View all 28

NPI Registry JSON

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

{
    "created_epoch": "1604966400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1604966400000",
    "number": "1467054924",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1201 PACIFIC AVE STE 400",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984024381",
            "telephone_number": "125-322-8990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 PACIFIC AVE STE 400",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984024381",
            "telephone_number": "253-300-8447"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARDIORENAL THERAPEUTICS OF WASHINGTON, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-11-10",
        "last_updated": "2020-11-10",
        "certification_date": "2020-11-10",
        "status": "A",
        "authorized_official_last_name": "SHAH",
        "authorized_official_first_name": "REHAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "516-721-7069",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tacoma, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.