NPIMap

Organization Active NPI

Evergreen Emergency Services, PS

  • Emergency Medicine Physician
  • Kirkland, WA
National Provider Identifier
1619912524
Registry record updated Nov 20, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
Legal business name
EVERGREEN EMERGENCY SERVICES, PS
Practice address
12040 NE 128TH St
Kirkland, WA 98034-3013
Phone
(206) 550-5253
NPI assigned
Jun 17, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 20, 2020

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

Authorized official

Name
Dr. Chad Crystal, MDNPI 1649234618
Title
President
Phone
(425) 899-1751

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207P00000X Primary

Addresses

Primary practice location

12040 NE 128TH St
Kirkland, WA 98034-3013

Mailing address

File 50421
Los Angeles, CA 90074-0001
Phone (855) 691-9890

Other identifiers 4

IdentifierTypeStateIssuer
184567OtherWASHINGTON CRIME VICTIMS
7122864MedicaidWA
8938298OtherWASHINGTON CRIME VICTIMS
604658700OtherUS DEPTARMENT OF LABOR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040518000743 WA Part B Supplier - Clinic/Group Practice 4981694155 Receives reassigned benefits from 76 practitioners
Practice locations: Kirkland, WA; Monroe, WA; Redmond, WA

National Provider Directory

National Provider Directory

Locations

File 50421
Los Angeles, CA 90074

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

8980 161st Ave NE
Ste 200
Redmond, WA 98052
Phone (425) 899-1111

Practitioners & affiliated clinicians

Practitioners 92

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 92

NPI Registry JSON

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

{
    "created_epoch": "1150502400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1605830400000",
    "number": "1619912524",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "FILE 50421",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900740001",
            "telephone_number": "855-691-9890"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12040 NE 128TH ST",
            "city": "KIRKLAND",
            "state": "WA",
            "postal_code": "980343013",
            "telephone_number": "206-550-5253"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN EMERGENCY SERVICES, PS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-17",
        "last_updated": "2020-11-20",
        "certification_date": "2020-11-20",
        "status": "A",
        "authorized_official_last_name": "CRYSTAL",
        "authorized_official_first_name": "CHAD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "425-899-1751",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WASHINGTON CRIME VICTIMS",
            "identifier": "184567",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7122864",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WASHINGTON CRIME VICTIMS",
            "identifier": "8938298",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "US DEPTARMENT OF LABOR",
            "identifier": "604658700",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kirkland, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.