NPIMap

Organization Active NPI

Pacific Islamic Community and Cultural Services

Doing business as PICACS Clinic

  • Community/Behavioral Health Agency
  • Bothell, WA
National Provider Identifier
1467905695
Registry record updated Jul 23, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
200385 Issued in WA
Legal business name
PACIFIC ISLAMIC COMMUNITY AND CULTURAL SERVICES
Doing business as
PICACS Clinic
Practice address
10634 E Riverside Dr
Suite 300
Bothell, WA 98011-3757
Phone
(425) 412-6318
NPI assigned
Jul 23, 2016
Last updated
Jul 23, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 23, 2016

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

Authorized official

Name
Dr. Syed Jamal Mustafa, MDNPI 1609883180
Title
Medical Director
Phone
(425) 806-5021

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X 200385 WA Primary

Addresses

Primary practice location

10634 E Riverside Dr
Suite 300
Bothell, WA 98011-3757

Mailing address

10634 E Riverside Dr
Suite 300
Bothell, WA 98011-3757
Phone (425) 412-6318

Other names 1

  • PICACS Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20171023002865 WA Part B Supplier - Clinic/Group Practice 0143596940 Receives reassigned benefits from 4 practitioners
Practice locations: Bothell, WA

National Provider Directory

National Provider Directory

Locations

10634 E Riverside Dr
Ste 300
Bothell, WA 98011
Phone (425) 412-6318

Practitioners & affiliated clinicians

Practitioners 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1469232000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1469232000000",
    "number": "1467905695",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10634 E RIVERSIDE DR",
            "address_2": "SUITE 300",
            "city": "BOTHELL",
            "state": "WA",
            "postal_code": "980113757",
            "telephone_number": "425-412-6318"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10634 E RIVERSIDE DR",
            "address_2": "SUITE 300",
            "city": "BOTHELL",
            "state": "WA",
            "postal_code": "980113757",
            "telephone_number": "425-412-6318"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFIC ISLAMIC COMMUNITY AND CULTURAL SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-07-23",
        "last_updated": "2016-07-23",
        "status": "A",
        "authorized_official_last_name": "MUSTAFA",
        "authorized_official_first_name": "SYED",
        "authorized_official_middle_name": "JAMAL",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "425-806-5021",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "WA",
            "license": "200385",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PICACS Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bothell, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2016; 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.