Individual provider Active NPI

Ilya Golovaty, M.D.

  • Internal Medicine Physician
  • Seattle, WA
National Provider Identifier
1497173371
Registry record updated Apr 9, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
A148806 Issued in CA
Practice address
1660 S Columbian Way
Seattle, WA 98108-1532
Phone
(206) 764-2936
NPI assigned
Mar 28, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 9, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Internal Medicine Physician 207R00000X A148806 CA Primary

Addresses

Primary practice location

1660 S Columbian Way
Seattle, WA 98108-1532

Mailing address

1660 S Columbian Way
Seattle, WA 98108-1532

Other practice location 1

1959 NE Pacific St Rm Bb-527
Box 356421
Seattle, WA 98195-6421
Phone (206) 543-3605

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20170607000981 CA Practitioner - Internal Medicine 3274858170 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A148806CAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University of California SFGH Medical Group Current Accepting new patients
University of California SFGH Medical Group CurrentSince May 19, 2017 Accepting new patients
University of California SFGH Medical Group Internal Medicine CurrentSince May 19, 2017 Accepting new patients

Locations

1001 Potrero Ave
Bldg 51M
San Francisco, CA 94110

1001 Potrero Ave
Rm 5H22
San Francisco, CA 94110
Phone (628) 206-4774

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1395964800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1586390400000",
    "number": "1497173371",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1660 S COLUMBIAN WAY",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981081532"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1660 S COLUMBIAN WAY",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981081532",
            "telephone_number": "206-764-2936"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1959 NE Pacific St Rm Bb-527",
            "address_2": "Box 356421",
            "address_purpose": "LOCATION",
            "city": "Seattle",
            "state": "WA",
            "postal_code": "981956421",
            "country_code": "US",
            "telephone_number": "206-543-3605",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GOLOVATY",
        "first_name": "ILYA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-03-28",
        "last_updated": "2020-04-09",
        "certification_date": "2020-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A148806",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Seattle, WA

Sources for this page

Verify at the official NPI Registry.