Individual provider Active NPI

Massoud Stephane, MD

  • Psychiatry Physician
  • Kirkland, WA
National Provider Identifier
1508941204
Registry record updated Mar 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
MD61413485 Issued in WA
Practice address
4030 Lake Washington Blvd NE Ste 303
Kirkland, WA 98033-7870
Phone
(253) 752-7320
NPI assigned
Oct 25, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 13, 2026

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X MD61413485 WA Primary
Psychiatry Physician 2084P0800X D0052816 MD
Psychiatry Physician 2084P0800X 01077111A IN

Addresses

Primary practice location

4030 Lake Washington Blvd NE Ste 303
Kirkland, WA 98033-7870

Mailing address

4030 Lake Washington Blvd NE Ste 303
Kirkland, WA 98033-7870
Phone (253) 752-7320

Other identifiers 1

IdentifierTypeStateIssuer
201369440MedicaidIN

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
I20230721000719 WA Practitioner - Psychiatry 5294989471 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Other, 1983
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Western Psychological and Counseling Services LLCGroup PAC ID 7719975085, 331 clinicians

Practice addresses (Care Compare)

4030 Lake Washington Blvd NE
Suite 303
Kirkland, WA 98033-7870
Phone (206) 910-9476

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
D0052816MDMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University Medical Diagnostic Associates, Inc. Past Accepting new patients
Western Psychological and Counseling Services LLC Psychiatry PastSince May 7, 2023 Accepting new patients

Interoperability endpoints

  • Direct secure messaging: lifestancehealth.massoudstephane@147765.advancedmd-direct.com

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": "1161734400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1773360000000",
    "number": "1508941204",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4030 LAKE WASHINGTON BLVD NE STE 303",
            "city": "KIRKLAND",
            "state": "WA",
            "postal_code": "980337870",
            "telephone_number": "253-752-7320"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4030 LAKE WASHINGTON BLVD NE STE 303",
            "city": "KIRKLAND",
            "state": "WA",
            "postal_code": "980337870",
            "telephone_number": "253-752-7320"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STEPHANE",
        "first_name": "MASSOUD",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-25",
        "last_updated": "2026-03-13",
        "certification_date": "2026-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "WA",
            "license": "MD61413485",
            "primary": true
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MD",
            "license": "D0052816",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "IN",
            "license": "01077111A",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201369440",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kirkland, WA

Sources for this page

Verify at the official NPI Registry.