Individual provider Active NPI

Peter Joseph Montano Edpao, M.D.

  • Surgery Physician
  • Seattle, WA
National Provider Identifier
1477992949
Registry record updated Mar 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
MD60842674 Issued in WA
Practice address
1959 NE Pacific St
Seattle, WA 98195
Phone
(206) 598-1819
NPI assigned
Jun 18, 2013
Last updated
Mar 30, 2021By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 30, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Transplant Surgery Physician 204F00000X MD60842674 WA
Surgery Physician 208600000X MD60842674 WA Primary

Addresses

Primary practice location

1959 NE Pacific St
Seattle, WA 98195

Mailing address

PO Box 50095
Seattle, WA 98145-5095

Other practice location 1

2930 Maple St
Everett, WA 98201-3832
Phone (425) 261-1500

Other identifiers 1

IdentifierTypeStateIssuer
1477992949MedicaidWA

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwa.kp.org:14430/Interconnect-CE-PRD/wcf/epic.community.hie/xcpdrespondinggatewaysync Health Information Exchange (HIE)

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
I20180628002477 WA Practitioner - General Surgery 6002162328 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
University of California, Geffen School of Medicine, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

2930 Maple St
Everett, WA 98201-3832
Phone (425) 261-1500

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD60842674WAMDTransplant Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The Association of Chrmc and University Physicians Surgery CurrentSince Jun 25, 2019 Accepting new patients
Kaiser Foundation Health Plan of Washington CurrentSince Jul 7, 2020 Accepting new patients
Kaiser Foundation Health Plan of Washington CurrentSince Jul 7, 2020 Accepting new patients
Association of CHMC and University Physicians CurrentSince Jun 25, 2019 Accepting new patients

Locations

2930 Maple St
Everett, WA 98201
Phone (425) 261-1500

900 Pacific Ave
Ste 100
Everett, WA 98201
Phone (425) 304-6080

200 15th Ave E
Seattle, WA 98112
Phone (206) 326-4530

4800 Sand Point Way NE
Seattle, WA 98105
Phone (206) 526-2000

9505 S Steele St
Tacoma, WA 98444
Phone (253) 597-6800

Interoperability endpoints

  • Direct secure messaging: pedpao555220@ghc.direct-ci.net

Organizations & group practices 4

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": "1371513600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617062400000",
    "number": "1477992949",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 50095",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981455095"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1959 NE PACIFIC ST",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "98195",
            "telephone_number": "206-598-1819"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2930 Maple St",
            "address_purpose": "LOCATION",
            "city": "Everett",
            "state": "WA",
            "postal_code": "982013832",
            "country_code": "US",
            "telephone_number": "425-261-1500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "EDPAO",
        "first_name": "PETER JOSEPH",
        "middle_name": "MONTANO",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-06-18",
        "last_updated": "2021-03-30",
        "certification_date": "2021-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "204F00000X",
            "taxonomy_group": "",
            "desc": "Transplant Surgery",
            "state": "WA",
            "license": "MD60842674",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "WA",
            "license": "MD60842674",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1477992949",
            "state": "WA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwa.kp.org:14430/Interconnect-CE-PRD/wcf/epic.community.hie/xcpdrespondinggatewaysync",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "2930 Maple St",
            "city": "Everett",
            "state": "WA",
            "country_code": "US",
            "postal_code": "982013832",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Seattle, WA

Sources for this page

Verify at the official NPI Registry.