Jaclyn Christine Omura, M.D

Primary specialty

Pediatric Rehabilitation Medicine PhysicianTaxonomy code 2081P0010X

License

MD60584257 Issued in WA

Practice address

4800 Sand Point Way NE
Seattle, WA 98105

Phone

(206) 987-2850

NPI assigned

May 31, 2013

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Ms. Jaclyn Christine Russell Former name

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jomura36922@direct.seattlechildrens.org

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.

• The Association of Chrmc and University Physicians

  dba Children's University Medical Group

  • Pediatrics Physician
  • Seattle, WA
  • NPI 1255449963
  Medicare reassignment NPD
• Association of CHMC and University Physicians

  • Pediatrics Physician
  • Richland, WA
  • NPI 1851680664
  NPD
• Seattle Children's Hospital

  • Rehabilitation Hospital Unit
  • Seattle, WA
  • NPI 1184708992
  NPD (past)
• Seattle Children's Hospital

  • Home Infusion Agency
  • Bothell, WA
  • NPI 1245383348
  NPD (past)

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

{
    "created_epoch": "1369958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1563408000000",
    "number": "1609213560",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5371",
            "address_2": "OD 8 410",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "98105",
            "telephone_number": "206-987-2850",
            "fax_number": "206-987-2651"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4800 SAND POINT WAY NE",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "98105",
            "telephone_number": "206-987-2850"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OMURA",
        "first_name": "JACLYN",
        "middle_name": "CHRISTINE",
        "name_prefix": "Mrs.",
        "credential": "M.D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-05-31",
        "last_updated": "2019-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2081P0010X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Pediatric Rehabilitation Medicine",
            "state": "WA",
            "license": "MD60584257",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACLYN",
            "last_name": "RUSSELL",
            "middle_name": "CHRISTINE",
            "prefix": "MS.",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Midori Omori, R.D.
• Joyce Emi Omoto, LMP
• Savannah N Omotto
• Gal Omry Orbach, M.D.
• Emily Miyuki Omura, M.D.
• Travis Allen Omura
• On Site Dermatology of Washington PLLC
• Cindy On, DDS
• Michelle Nooryi On, DPT
• Natalia Isabelle Oncina, LMHC

• Pediatric Rehabilitation Medicine Physician in Seattle, WA
• Providers in Seattle, WA by specialty
• Pediatric Rehabilitation Medicine Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.