Individual provider Active NPI

John Francis Lubetich Jr., MD

  • Anesthesiology Physician
  • Bremerton, WA
National Provider Identifier
1568523595
Registry record updated Jan 21, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
MD00028423 Issued in WA
Practice address
990 Sylvan Way
Bremerton, WA 98310-2851
Phone
(360) 479-3657
Fax
(360) 373-7616
NPI assigned
Dec 13, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 21, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X MD00028423 WA Primary

Addresses

Primary practice location

990 Sylvan Way
Bremerton, WA 98310-2851

Mailing address

990 Sylvan Way
Bremerton, WA 98310-2851
Phone (360) 479-3657

Other identifiers 8

IdentifierTypeStateIssuer
1065747MedicaidWA
192575000OtherWAOWCP
LU0376OtherWAREGENCE
911577098OtherWAUNIFORM MEDICAL PLAN
911577098OtherWAPREMERA BLUE CROSS
911577098-04OtherWAKITSAP PHYSICIANS SERVICE
013194010OtherWAGROUP HEALTH COOPERATIVE
38303OtherWALABOR AND INDUSTRIES

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD00028423WAMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Independent Anesthesiologists of Kitsap Co Anesthesiology Past Accepting new patients

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1165968000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1232496000000",
    "number": "1568523595",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "990 SYLVAN WAY",
            "city": "BREMERTON",
            "state": "WA",
            "postal_code": "983102851",
            "telephone_number": "360-479-3657",
            "fax_number": "360-373-7616"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "990 SYLVAN WAY",
            "city": "BREMERTON",
            "state": "WA",
            "postal_code": "983102851",
            "telephone_number": "360-479-3657",
            "fax_number": "360-373-7616"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LUBETICH",
        "first_name": "JOHN",
        "middle_name": "FRANCIS",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-13",
        "last_updated": "2009-01-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "WA",
            "license": "MD00028423",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1065747",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OWCP",
            "identifier": "192575000",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE",
            "identifier": "LU0376",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNIFORM MEDICAL PLAN",
            "identifier": "911577098",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREMERA BLUE CROSS",
            "identifier": "911577098",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KITSAP PHYSICIANS SERVICE",
            "identifier": "911577098-04",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP HEALTH COOPERATIVE",
            "identifier": "013194010",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LABOR AND INDUSTRIES",
            "identifier": "38303",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bremerton, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2009; 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.