NPIMap

Individual provider Active NPI

Syed Jamal Mustafa, M.D.

  • Psychiatry Physician
  • Bothell, WA
National Provider Identifier
1609883180
Registry record updated Jul 1, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
MD00034219 Issued in WA
Practice address
10634 E Riverside Dr Ste 130
Bothell, WA 98011-3758
Phone
(425) 806-5021
NPI assigned
Aug 1, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 1, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X MD00034219 WA Primary

Addresses

Primary practice location

10634 E Riverside Dr Ste 130
Bothell, WA 98011-3758

Mailing address

PO Box 4247
Bellevue, WA 98009-4247
Phone (425) 488-7367

Other identifiers 1

IdentifierTypeStateIssuer
1112333MedicaidWA

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
I20070801000767 WA Practitioner - Psychiatry 2365533544 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
University of Washington School of Medicine, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Puget Sound Psychiatric Center PSGroup PAC ID 4688766066, 5 clinicians
BHC Fairfax Hospital IncGroup PAC ID 1153231857, 32 clinicians

Practice addresses (Care Compare)

10634 E Riverside Dr
Suite 130
Bothell, WA 98011-3758
Phone (425) 806-5021

14701 179TH Ave SE
Monroe, WA 98272-1108
Phone (360) 365-5300

Merit-based Incentive Payment System (MIPS)

Final score
83.24 of 100Reported as group
Quality
76.66
Improvement activities
40
Cost
70.27

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Puget Sound Psychiatric Center, PS Psychiatry CurrentSince Aug 1, 2007 Accepting new patients
Pacific Islamic Community and Cultural Services CurrentSince Oct 20, 2017 Accepting new patients
BHC Fairfax Hospital Inc. Psychiatry CurrentSince Oct 29, 2018 Accepting new patients
Puget Sound Psychiatric Services Psychiatry Past Accepting new patients
BHC Fairfax Hospital Inc Past Accepting new patients
Pacific Medical Evaluations and Treatment Services, PLLC PastSince Oct 27, 2008 Accepting new patients
Center for Assessment & Therapy Services PS Past Accepting new patients
Compass Health Past Accepting new patients
Puget Sound Psychiatric Center Psychiatry Past Accepting new patients

Locations

10634 E Riverside Dr
Ste 130
Bothell, WA 98011
Phone (425) 806-5021

916 Pacific Ave
Fl 7
Everett, WA 98201
Phone (425) 303-6500

10200 NE 132nd St
Kirkland, WA 98034
Phone (425) 821-2000

14701 179th Ave SE
Monroe, WA 98272
Phone (360) 794-1409

Organizations & group practices 9

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": "1154390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1214870400000",
    "number": "1609883180",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4247",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980094247",
            "telephone_number": "425-488-7367",
            "fax_number": "425-488-8516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10634 E RIVERSIDE DR STE 130",
            "city": "BOTHELL",
            "state": "WA",
            "postal_code": "980113758",
            "telephone_number": "425-806-5021"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MUSTAFA",
        "first_name": "SYED",
        "middle_name": "JAMAL",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-01",
        "last_updated": "2008-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "WA",
            "license": "MD00034219",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1112333",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bothell, WA

Sources for this page

Verify at the official NPI Registry.