Individual provider Active NPI

Jimena Maria Gomez del Carpio, M.D.

  • Family Medicine Physician
  • Monroe, WA
National Provider Identifier
1619173614
Registry record updated Aug 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD61325030 Issued in WA
Practice address
14841 179TH Ave SE
Monroe, WA 98272-1127
Phone
(360) 217-1155
Fax
(360) 217-1154
NPI assigned
Jun 26, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 4, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MD61325030 WA Primary

Addresses

Primary practice location

14841 179TH Ave SE
Monroe, WA 98272-1127

Mailing address

14841 179TH Ave SE
Monroe, WA 98272-1127
Phone (360) 217-1155

Other identifiers 1

IdentifierTypeStateIssuer
MD61325030OtherWAWA STATE LICENSE NUMBER

Electronic endpoints 2

TypeEndpointUseAffiliation
SOAP URL https://careepiceast.kp.org:14430/Interconnect-prodmam/wcf/epic.community.hie/xcpdrespondinggat Health Information Exchange (HIE)
SOAP URL https://careepiceast.kp.org:14430/Interconnect-prodmam/wcf/epic.community.hie/xcpdrespondinggateways Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20221129000726 WA Practitioner - Family Practice 6709072283 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

12333 NE 130TH LN
Suite 310
Kirkland, WA 98034-7467
Phone (425) 899-6700

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
86.73 of 100Reported as apm
Quality
73.46
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
King County Public Hospital District No 2 Current Accepting new patients
King County Public Hospital District No. 2 Family Medicine Current Accepting new patients
King County Public Hospital District No 2 Family Medicine CurrentSince Nov 1, 2022 Accepting new patients
King County Public Hospital District No. 2 CurrentSince Nov 1, 2022 Accepting new patients
King County Public Hospital District No 2 Past Accepting new patients
NYU Lutheran Medical Center Past Accepting new patients

Locations

1909 214th St SE
Ste 110
Bothell, WA 98021
Phone (425) 488-4988

14720 Main St NE
Ste 109
Duvall, WA 98019
Phone (425) 788-4889

12039 NE 128th St
Ste 300
Kirkland, WA 98034
Phone (425) 899-3123

12040 NE 128th St
#50
Kirkland, WA 98034
Phone (425) 899-1894

12333 NE 130th Ln
Ste 310
Kirkland, WA 98034
Phone (425) 899-6700

14841 179th Ave SE
Monroe, WA 98272
Phone (360) 217-1155

14841 179th Ave SE
Ste 210
Monroe, WA 98272
Phone (360) 217-1155

Organizations & group practices 6

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.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1182816000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691107200000",
    "number": "1619173614",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14841 179TH AVE SE",
            "city": "MONROE",
            "state": "WA",
            "postal_code": "982721127",
            "telephone_number": "360-217-1155",
            "fax_number": "360-217-1154"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14841 179TH AVE SE",
            "city": "MONROE",
            "state": "WA",
            "postal_code": "982721127",
            "telephone_number": "360-217-1155",
            "fax_number": "360-217-1154"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOMEZ DEL CARPIO",
        "first_name": "JIMENA",
        "middle_name": "MARIA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-26",
        "last_updated": "2023-08-04",
        "certification_date": "2023-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "MD61325030",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WA STATE LICENSE NUMBER",
            "identifier": "MD61325030",
            "state": "WA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepiceast.kp.org:14430/Interconnect-prodmam/wcf/epic.community.hie/xcpdrespondinggat",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "43408 Yukon Drive",
            "city": "Ashburn",
            "state": "VA",
            "country_code": "US",
            "postal_code": "20147",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepiceast.kp.org:14430/Interconnect-prodmam/wcf/epic.community.hie/xcpdrespondinggateways",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "43408 Yukon Drive",
            "city": "Ashburn",
            "state": "VA",
            "country_code": "US",
            "postal_code": "20147",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Monroe, WA

Sources for this page

Verify at the official NPI Registry.