NPIMap

Individual provider Active NPI

John R. Knudsen, M.D.

  • Emergency Medical Services (Emergency Medicine) Physician
  • Ferndale, WA
National Provider Identifier
1508952060
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medical Services (Emergency Medicine) PhysicianTaxonomy code 207PE0004X
License
MD00013215 Issued in WA
Practice address
6046 Portal Way
Ste 103
Ferndale, WA 98248-7829
Phone
(360) 734-2330
Fax
(360) 733-3886
NPI assigned
Oct 4, 2006
Last updated
Mar 7, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medical Services (Emergency Medicine) Physician 207PE0004X MD00013215 WA Primary
General Practice Physician 208D00000X MD00013215 WA

Addresses

Primary practice location

6046 Portal Way
Ste 103
Ferndale, WA 98248-7829

Mailing address

1260 Maralee Lane
Bellingham, WA 98226
Phone (360) 393-4142

Other identifiers 4

IdentifierTypeStateIssuer
1466705MedicaidWA
151150OtherWAL&I
5824KNOtherWAREG RYDER
50D0856491OtherWACLIA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070102000491 WA Practitioner - General Practice 3577563253 Practice locations: Ferndale, WA

Care Compare profile

Medicare Care Compare
Specialty
General Practice
Education
University of Washington School of Medicine, 1970
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

6046 Portal Way
Suite 103
Ferndale, WA 98248-7829
Phone (360) 483-5260

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of nail tissue1-10
Removal or shaving of skin growth1-10
Skin biopsy19

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD00013215WAMDGeneral Practice Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Walk in Health Clinic Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: jknudsen@johnrknudsenmd.amazing-direct.com

Organizations & group practices 1

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.

Hospital & facility affiliations 6

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": "1159920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1508952060",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1260 MARALEE LANE",
            "city": "BELLINGHAM",
            "state": "WA",
            "postal_code": "98226",
            "telephone_number": "360-393-4142"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6046 PORTAL WAY",
            "address_2": "STE 103",
            "city": "FERNDALE",
            "state": "WA",
            "postal_code": "982487829",
            "telephone_number": "360-734-2330",
            "fax_number": "360-733-3886"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KNUDSEN",
        "first_name": "JOHN",
        "middle_name": "R.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-04",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207PE0004X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Emergency Medical Services",
            "state": "WA",
            "license": "MD00013215",
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "WA",
            "license": "MD00013215",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1466705",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "L&I",
            "identifier": "151150",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REG RYDER",
            "identifier": "5824KN",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "50D0856491",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ferndale, WA

Sources for this page

Verify at the official NPI Registry.