Individual provider Active NPI

Maria D Fan, MD

  • Internal Medicine Physician
  • Seattle, WA
National Provider Identifier
1497020580
Registry record updated Jul 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD60535288 Issued in WA
Practice address
515 Minor Ave Ste 300
Seattle, WA 98104-2133
Phone
(206) 386-9500
Fax
(206) 386-9605
NPI assigned
Mar 21, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 25, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD60535288 WA Primary

Addresses

Primary practice location

515 Minor Ave Ste 300
Seattle, WA 98104-2133

Mailing address

PO Box 25608
Salt Lake City, UT 84125-0608
Phone (206) 320-4476

Other identifiers 1

IdentifierTypeStateIssuer
2046556MedicaidWA

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
I20150817002527 WA Practitioner - Internal Medicine 8527373794 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Albert Einstein College of Medicine of Yeshiva University, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Swedish Health ServicesGroup PAC ID 9537072814, 384 clinicians

Practice addresses (Care Compare)

515 Minor Ave
Suite 300
Seattle, WA 98104-2133
Phone (206) 386-9505

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD60535288WAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Swedish Health Services Internal Medicine CurrentSince May 9, 2022 Accepting new patients
Kaiser Foundation Health Plan of Washington CurrentSince Apr 9, 2017 Accepting new patients
Kaiser Foundation Health Plan of Washington CurrentSince Apr 9, 2017 Accepting new patients
Kaiser Foundation Health Plan of Washington Current Accepting new patients
Swedish Health Services CurrentSince May 9, 2022 Accepting new patients

Locations

13451 SE 36th St
Bellevue, WA 98006
Phone (425) 562-1316

13020 Meridian Ave S
Everett, WA 98208
Phone (425) 357-3700

515 Minor Ave
Ste 300
Seattle, WA 98104
Phone (206) 386-9505

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

2450 33rd Ave W
Ste 100
Seattle, WA 98199
Phone (206) 320-3364

800 5th Ave
Ste 800
Seattle, WA 98104
Phone (206) 533-2944

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

Interoperability endpoints

  • Direct secure messaging: mfan2293059@wm.providencedirect.org
  • Direct secure messaging: mfan179047@ghc.direct-ci.net

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1332288000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658707200000",
    "number": "1497020580",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 25608",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841250608",
            "telephone_number": "206-320-4476",
            "fax_number": "206-568-7043"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "515 MINOR AVE STE 300",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981042133",
            "telephone_number": "206-386-9500",
            "fax_number": "206-386-9605"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAN",
        "first_name": "MARIA",
        "middle_name": "D",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-03-21",
        "last_updated": "2022-07-25",
        "certification_date": "2022-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WA",
            "license": "MD60535288",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2046556",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Seattle, WA

Sources for this page

Verify at the official NPI Registry.