NPIMap

Organization Active NPI

Functional Health Consulting, LLC

Doing business as Vida Integrated Health

  • Sports Physician Chiropractor
  • Seattle, WA
National Provider Identifier
1538645288
Registry record updated Jul 16, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Physician ChiropractorTaxonomy code 111NS0005X
Legal business name
FUNCTIONAL HEALTH CONSULTING, LLC
Doing business as
Vida Integrated Health
Practice address
4915 25TH Ave NE Ste 104
Seattle, WA 98105-8667
Phone
(206) 315-7998
Fax
(206) 316-2308
NPI assigned
Jul 16, 2018
Organization subpart
Yes
Parent organization
FUNCTIONAL HEALTH CONSULTING, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 16, 2018

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

Authorized official

Name
Debbie Troxler
Title
Billing Specialist
Phone
(425) 355-5222

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Physician ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111NS0005X Primary

Addresses

Primary practice location

4915 25TH Ave NE Ste 104
Seattle, WA 98105-8667

Mailing address

15 SW Everett Mall Way Ste G
Everett, WA 98204-2715
Phone (425) 355-5222

Other names 1

  • Vida Integrated Health Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110124000928 WA Part B Supplier - Clinic/Group Practice 1759560709 Receives reassigned benefits from 41 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Seattle, WA; Renton, WA; Everett, WA; Bellevue, WA; Kirkland, WA

Other NPIs on the same Medicare enrollment 5

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
50D2069579Vida Integrated Health4915 25TH Ave NE Ste 104, Seattle, WA 98105Certificate of waiverApr 4, 2028

National Provider Directory

National Provider Directory
Tax ID family
Functional Health Consulting LLC4 organizations share this tax ID, including this one
Part of
Functional Health Consulting LLC

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

11901 NE Village Plz
Ste 261
Kirkland, WA 98034
Phone (425) 814-2800

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1531699200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1531699200000",
    "number": "1538645288",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 SW EVERETT MALL WAY STE G",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982042715",
            "telephone_number": "425-355-5222",
            "fax_number": "425-355-5231"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4915 25TH AVE NE STE 104",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981058667",
            "telephone_number": "206-315-7998",
            "fax_number": "206-316-2308"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FUNCTIONAL HEALTH CONSULTING, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FUNCTIONAL HEALTH CONSULTING, LLC",
        "enumeration_date": "2018-07-16",
        "last_updated": "2018-07-16",
        "status": "A",
        "authorized_official_last_name": "TROXLER",
        "authorized_official_first_name": "DEBBIE",
        "authorized_official_title_or_position": "BILLING SPECIALIST",
        "authorized_official_telephone_number": "425-355-5222"
    },
    "taxonomies": [
        {
            "code": "111NS0005X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor, Sports Physician",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Vida Integrated Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Seattle, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.