NPIMap

Organization Active NPI

Evergreen Diabetes & Endocrinology Medical Group, PLLC

  • Endocrinology, Diabetes & Metabolism Physician
  • Kirkland, WA
National Provider Identifier
1497766190
Registry record updated Jul 23, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X
License
602612648 Issued in WA
Legal business name
EVERGREEN DIABETES & ENDOCRINOLOGY MEDICAL GROUP, PLLC
Practice address
13118 121St Way NE
Suite 103
Kirkland, WA 98034-3004
Phone
(425) 899-6414
Fax
(425) 899-4066
NPI assigned
Aug 10, 2006
Last updated
Jul 23, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 23, 2008

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

Authorized official

Name
Dr. Edward Courtright La Cava, M.D.NPI 1942239413
Title
Owner
Phone
(425) 899-6414

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Endocrinology, Diabetes & Metabolism PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RE0101X 602612648 WA Primary

Addresses

Primary practice location

13118 121St Way NE
Suite 103
Kirkland, WA 98034-3004

Mailing address

13118 121 Way NE
Suite 103
Kirkland, WA 98034-3004
Phone (425) 899-6414

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1155168000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1216771200000",
    "number": "1497766190",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13118 121 WAY NE",
            "address_2": "SUITE 103",
            "city": "KIRKLAND",
            "state": "WA",
            "postal_code": "980343004",
            "telephone_number": "425-899-6414",
            "fax_number": "425-899-4066"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13118 121ST WAY NE",
            "address_2": "SUITE 103",
            "city": "KIRKLAND",
            "state": "WA",
            "postal_code": "980343004",
            "telephone_number": "425-899-6414",
            "fax_number": "425-899-4066"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN DIABETES & ENDOCRINOLOGY MEDICAL GROUP, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-10",
        "last_updated": "2008-07-23",
        "status": "A",
        "authorized_official_last_name": "LA CAVA",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_middle_name": "COURTRIGHT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "425-899-6414",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RE0101X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "WA",
            "license": "602612648",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kirkland, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2008; 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.