NPIMap

Organization Active NPI

Provail

  • Speech-Language Pathologist
  • Seattle, WA
National Provider Identifier
1477760197
Registry record updated Jun 21, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
SI00004391 Issued in WA
Legal business name
PROVAIL
Practice address
12550 Aurora Ave N
Seattle, WA 98133-8036
Phone
(206) 363-7303
Fax
(206) 826-0181
NPI assigned
May 16, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 21, 2018

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

Authorized official

Name
Mr. Michael Hatzenbeler
Title
Ceo
Phone
(206) 363-7303

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language PathologistGroup: 193200000X MULTI-SPECIALTY GROUP 235Z00000X SI00004391 WA Primary

Addresses

Primary practice location

12550 Aurora Ave N
Seattle, WA 98133-8036

Mailing address

12550 Aurora Ave N
Seattle, WA 98133-8036
Phone (206) 363-7303

Other identifiers 7

IdentifierTypeStateIssuer
55-0174569OtherWALABOR AND INDUSTRIES
7070949-8347395MedicaidWA
7681083-8464992MedicaidWA
7368087OtherWAAETNA CLINIC NUMBER
7070949-8347429MedicaidWA
7681083-8415291MedicaidWA
397572001OtherWAGROUP HEALTH PROVIDER NUM

Other names 1

  • PROVAIL Therapeutic and Assistive Technology Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090225000607 WA Part A Provider - Outpatient Physical Therapy/Occupational Therapy/Speech Pathology Services 5395801435 Practice locations: Seattle, WA

National Provider Directory

National Provider Directory
Tax ID family
Provail Dental Clinic3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1179273600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529539200000",
    "number": "1477760197",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12550 AURORA AVE N",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981338036",
            "telephone_number": "206-363-7303",
            "fax_number": "206-826-0181"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12550 AURORA AVE N",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981338036",
            "telephone_number": "206-363-7303",
            "fax_number": "206-826-0181"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVAIL",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-16",
        "last_updated": "2018-06-21",
        "status": "A",
        "authorized_official_last_name": "HATZENBELER",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "206-363-7303",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": "WA",
            "license": "SI00004391",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LABOR AND INDUSTRIES",
            "identifier": "55-0174569",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7070949-8347395",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7681083-8464992",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA CLINIC NUMBER",
            "identifier": "7368087",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7070949-8347429",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7681083-8415291",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP HEALTH PROVIDER NUM",
            "identifier": "397572001",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PROVAIL Therapeutic and Assistive Technology Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Seattle, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2018; 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.