Rocky William Mazzeo, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

MD00027747 Issued in WA

Practice address

6007B 244TH St SW
Ballinger Clinic
Mountlake Terrace, WA 98043

Phone

(425) 640-4830

Fax

(425) 640-4885

NPI assigned

Aug 4, 2006

Last updated

Oct 8, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Ballinger Clinic, PLLC

  • Family Medicine Physician
  • Mountlake Terrace, WA
  • NPI 1982791349
  Authorized official Same address or phone
• Public Hospital District 2 of Snohomish County

  dba Stevens Pain Treatment Center

  • Pain Clinic/Center
  • Edmonds, WA
  • NPI 1407167513
  NPD (past)

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

{
    "created_epoch": "1154649600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602115200000",
    "number": "1487662235",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6007B 244TH ST SW",
            "address_2": "BALLINGER CLINIC",
            "city": "MOUNTLAKE TERRACE",
            "state": "WA",
            "postal_code": "98043",
            "telephone_number": "425-640-4830",
            "fax_number": "425-640-4885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6007B 244TH ST SW",
            "address_2": "BALLINGER CLINIC",
            "city": "MOUNTLAKE TERRACE",
            "state": "WA",
            "postal_code": "98043",
            "telephone_number": "425-640-4830",
            "fax_number": "425-640-4885"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAZZEO",
        "first_name": "ROCKY",
        "middle_name": "WILLIAM",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-04",
        "last_updated": "2020-10-08",
        "certification_date": "2020-10-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "MD00027747",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8127532",
            "state": "WA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rmazzeo1042457@wm.providencedirect.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "6007B 244th St SW",
            "address_2": "Ballinger Clinic",
            "city": "Mountlake Terrace",
            "state": "WA",
            "country_code": "US",
            "postal_code": "98043",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• BJ Maule, M.S., CCC-SP
• Maxim Healthcare Services Inc.
• Maxim Healthcare Services, Inc.
• Mayemura, Inc. (Mountlake Terrace Eye Care)
• Brandee Mayton
• Agnes Mbatia, ARNP
• Raniyah Mbecah
• Uzoma Obinna Mbogu
• Scott J McCorkell, MD
• Jennifer McGrath, LMHC

• Family Medicine Physician in Mountlake Terrace, WA
• Providers in Mountlake Terrace, WA by specialty
• Family Medicine Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.