NPIMap

Organization Active NPI

International Community Health Services

  • Registered Dietitian
  • Seattle, WA
National Provider Identifier
1609451566
Registry record updated Sep 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
Legal business name
INTERNATIONAL COMMUNITY HEALTH SERVICES
Practice address
720 8TH Ave S
Seattle, WA 98104-3032
Phone
(206) 788-3700
NPI assigned
Mar 12, 2021
Last updated
Sep 30, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
600436519As reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 30, 2024

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

Authorized official

Name
Hermes Shahbazian
Title
Cfo
Phone
(206) 788-3618

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X
Registered Dietitian 133V00000X Primary

Addresses

Primary practice location

720 8TH Ave S
Seattle, WA 98104-3032

Mailing address

PO Box 3007
Seattle, WA 98114-3007
Phone (206) 788-3605

Other practice location 1

1050 140th Ave NE
Bellevue, WA 98005-2972
Phone (425) 373-3000

Other practice location 2

16549 Aurora Ave N
Shoreline, WA 98133-5308
Phone (206) 533-2600

Other practice location 3

3815 S Othello St Fl 2
Seattle, WA 98118-3510
Phone (206) 788-3500

Other practice location 4

3639 Martin Luther King Jr Way S
Seattle, WA 98144-6847
Phone (206) 788-3605

Other names 1

  • ICHS Diabetes Education and Prevention Program Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031118000233 WA Part A Provider - Federally Qualified Health Center (FQHC) 5799695672 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Seattle, WA
O20040301000204 WA Part B Supplier - Clinic/Group Practice 5799695672 Receives reassigned benefits from 130 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Bellevue, WA; Seattle, WA; Shoreline, WA; Auburn, WA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1609451566. Details of each certification follow.

Federally qualified health center certification: CCN 501806

Legal name
INTERNATIONAL COMMUNITY HEALTH SERVICES
Doing business as
INTERNATIONAL DISTRICT CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 1, 1992
Last certification
Jan 1, 1992
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Sep 4, 1973 in WA
Enrollment address
720 8TH Ave S
Seattle, WA 98104-3032

Other NPIs on the same Medicare enrollment 6

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

National Provider Directory

National Provider Directory
Tax ID family
International District33 organizations share this tax ID, including this one
Part of
International District

Other organizations with this tax ID 31

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

View all 31

Locations

3815 S Othello St
Fl 2
Seattle, WA 98118
Phone (206) 788-3500

Ownership & related parties

All disclosed owners & managing parties 9

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Mariam Abarientos Individual Corporate DirectorVolunteer Board Director Mar 22, 2017
Hermes Shahbzian Individual Corporate DirectorCfo Nov 19, 2003
W-2 Managing EmployeeCfo Jan 1, 2003
Catherine Johnson Individual Corporate DirectorVolunteer Board Director Jul 25, 2012
Gildas Cheung Individual Corporate DirectorChairman of the Board Jan 28, 2009
John Foz Individual Corporate DirectorVolunteer Board Director Sep 24, 2008
Marvin Eng Individual Corporate DirectorVolunteer Board Director Nov 27, 2019
Chengzhen Dai Individual Corporate DirectorVolunteer Board Director May 27, 2020
Amanda Kimura Individual Corporate DirectorVolunteer Board Director Aug 29, 2018
Kelli Nomura Individual Corporate OfficerCeo Nov 7, 2022
W-2 Managing EmployeeCeo Nov 7, 2022

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1615507200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727654400000",
    "number": "1609451566",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3007",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981143007",
            "telephone_number": "206-788-3605"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "720 8TH AVE S",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981043032",
            "telephone_number": "206-788-3700"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1050 140th Ave NE",
            "address_purpose": "LOCATION",
            "city": "Bellevue",
            "state": "WA",
            "postal_code": "980052972",
            "country_code": "US",
            "telephone_number": "425-373-3000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "16549 Aurora Ave N",
            "address_purpose": "LOCATION",
            "city": "Shoreline",
            "state": "WA",
            "postal_code": "981335308",
            "country_code": "US",
            "telephone_number": "206-533-2600",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3815 S Othello St Fl 2",
            "address_purpose": "LOCATION",
            "city": "Seattle",
            "state": "WA",
            "postal_code": "981183510",
            "country_code": "US",
            "telephone_number": "206-788-3500",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3639 Martin Luther King Jr Way S",
            "address_purpose": "LOCATION",
            "city": "Seattle",
            "state": "WA",
            "postal_code": "981446847",
            "country_code": "US",
            "telephone_number": "206-788-3605",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "INTERNATIONAL COMMUNITY HEALTH SERVICES",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "600436519",
        "enumeration_date": "2021-03-12",
        "last_updated": "2024-09-30",
        "certification_date": "2024-09-30",
        "status": "A",
        "authorized_official_last_name": "SHAHBAZIAN",
        "authorized_official_first_name": "HERMES",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "206-788-3618"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ICHS Diabetes Education and Prevention Program",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "ICHS Diabetes Education and Prevention Program",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Seattle, WA

Sources for this page

Verify at the official NPI Registry.