NPIMap

Individual provider Active NPI

Mathini Sivakami Mohanachandran, M.D.

  • Internal Medicine Physician
  • Lynnwood, WA
National Provider Identifier
1528590767
Registry record updated Nov 10, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD61069435 Issued in WA
Practice address
19116 33Rd Ave W
Lynnwood, WA 98036-4706
Phone
(425) 712-7900
Fax
(425) 712-7905
NPI assigned
Mar 28, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 10, 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 MD61069435 WA Primary

Addresses

Primary practice location

19116 33Rd Ave W
Lynnwood, WA 98036-4706

Mailing address

19116 33Rd Ave W
Lynnwood, WA 98036-4706
Phone (425) 712-7900

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
I20200722000649 WA Practitioner - Internal Medicine 2365710449 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Washington School of Medicine, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Virginia Mason Medical CenterGroup PAC ID 9830002617, 867 clinicians
Select Outpatient Services IncGroup PAC ID 4082868815, 750 clinicians
Select Rehabilitation, LLCGroup PAC ID 9032020490, 1,935 clinicians

Practice addresses (Care Compare)

19116 33Rd Ave W
Lynnwood, WA 98036-4706
Phone (425) 712-7900

2600 Compass Rd
Glenview, IL 60026-8001

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD61069435WAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Virginia Mason Medical Center Current Accepting new patients
Virginia Mason Medical Center CurrentSince Jul 27, 2020 Accepting new patients
Virginia Mason Medical Center Internal Medicine CurrentSince Jul 27, 2020 Accepting new patients
Virginia Mason Medical Center Past Accepting new patients
Seattle King Co Dept of Public Health Past Accepting new patients

Locations

380 Winslow Way E
Bainbridge Island, WA 98110
Phone (206) 842-5632

19116 33rd Ave W
Lynnwood, WA 98036
Phone (425) 712-7900

925 Seneca St
Seattle, WA 98101
Phone (206) 341-0860

925 Seneca St
Stop H8GME
Seattle, WA 98101
Phone (206) 583-6079

4575 Sand Point Way NE
Ste 108
Seattle, WA 98105
Phone (206) 525-8000

Interoperability endpoints

  • Direct secure messaging: mmohanachandran211373@direct.ochin.org

Organizations & group practices 7

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 7

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": "1490659200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604966400000",
    "number": "1528590767",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19116 33RD AVE W",
            "city": "LYNNWOOD",
            "state": "WA",
            "postal_code": "980364706",
            "telephone_number": "425-712-7900",
            "fax_number": "425-712-7905"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19116 33RD AVE W",
            "city": "LYNNWOOD",
            "state": "WA",
            "postal_code": "980364706",
            "telephone_number": "425-712-7900",
            "fax_number": "425-712-7905"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOHANACHANDRAN",
        "first_name": "MATHINI",
        "middle_name": "SIVAKAMI",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-03-28",
        "last_updated": "2020-11-10",
        "certification_date": "2020-11-10",
        "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": "WA",
            "license": "MD61069435",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lynnwood, WA

Sources for this page

Verify at the official NPI Registry.