Individual provider Active NPI

Ashley Marlene Antonoff, D.C.

  • Chiropractor
  • Bellevue, WA
National Provider Identifier
1497053805
Registry record updated Jan 23, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
CH60211316 Issued in WA
Practice address
14777 NE 40TH St
#102
Bellevue, WA 98007-3300
Phone
(425) 883-2543
Fax
(425) 867-1109
NPI assigned
Mar 9, 2011
Last updated
Jan 23, 2017By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X CH60211316 WA Primary

Addresses

Primary practice location

14777 NE 40TH St
#102
Bellevue, WA 98007-3300

Mailing address

14777 NE 40TH St
#102
Bellevue, WA 98007-3300
Phone (425) 883-2543

Other identifiers 1

IdentifierTypeStateIssuer
CH60211316OtherWAWASHINGTON STATE CHIROPRACTIC LICENSE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110406000720 WA Practitioner - Chiropractic 0446434096 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Palmer College Chiropractic - Davenport, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ashley Antonoff PSGroup PAC ID 4880648013, 2 clinicians

Practice addresses (Care Compare)

8250 165TH Ave NE
Suite 100
Redmond, WA 98052-6628
Phone (425) 883-2543

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Kaufman Chiropractic Clinic Inc Chiropractor CurrentSince Mar 7, 2011 Accepting new patients
Bothell Regenerative Medicine Past Accepting new patients

Locations

18920 Bothell Way NE
Ste 100
Bothell, WA 98011
Phone (425) 486-1122

Organizations & group practices 3

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": "1299628800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1485129600000",
    "number": "1497053805",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14777 NE 40TH ST",
            "address_2": "#102",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980073300",
            "telephone_number": "425-883-2543",
            "fax_number": "425-867-1109"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14777 NE 40TH ST",
            "address_2": "#102",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980073300",
            "telephone_number": "425-883-2543",
            "fax_number": "425-867-1109"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANTONOFF",
        "first_name": "ASHLEY",
        "middle_name": "MARLENE",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-03-09",
        "last_updated": "2017-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "WA",
            "license": "CH60211316",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WASHINGTON STATE CHIROPRACTIC LICENSE",
            "identifier": "CH60211316",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bellevue, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.