NPIMap

Individual provider Active NPI

Courtney Anne Canavera, M.D.

  • Family Medicine Physician
  • Seattle, WA
National Provider Identifier
1639254576
Registry record updated Oct 7, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD00043403 Issued in WA
Practice address
1601 5TH Ave
Seattle, WA 98101-3621
Phone
(206) 623-7671
NPI assigned
Oct 26, 2006
Last updated
Oct 7, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 7, 2020

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 MD00043403 WA Primary

Addresses

Primary practice location

1601 5TH Ave
Seattle, WA 98101-3621

Mailing address

275 W Roy St
#410
Seattle, WA 98119-4520
Phone (206) 285-4857

Other practice location 1

751 NE Blakely Dr Ste 5010
Issaquah, WA 98029-6201
Phone (425) 394-0700

Other identifiers 1

IdentifierTypeStateIssuer
8394124MedicaidWA

Other names 1

  • Dr. Courtney Anne Lando Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address ccanavera1041261@wm.providencedirect.org Direct

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
I20040611000456 WA Practitioner - Family Practice 8426031279 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Washington School of Medicine, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Select Outpatient Services IncGroup PAC ID 4082868815, 750 clinicians
Select Rehabilitation, LLCGroup PAC ID 9032020490, 1,935 clinicians
Swedish Health ServicesGroup PAC ID 9537072814, 384 clinicians

Practice addresses (Care Compare)

2600 Compass Rd
Glenview, IL 60026-8001

751 NE Blakely Dr
Suite 5010
Issaquah, WA 98029-6201
Phone (425) 394-0700

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Swedish Health Services CurrentSince Feb 1, 2012 Accepting new patients
Swedish Health Services CurrentSince Jan 19, 2009 Accepting new patients
Swedish Health Services Family Medicine CurrentSince Feb 1, 2012 Accepting new patients
Maniilaq Association Past Accepting new patients
Caresimple Providers PS Family Medicine Past Accepting new patients
Maniilaq Association Past Accepting new patients
Carena Medical Providers PS Family Medicine Past Accepting new patients

Locations

751 NE Blakely Dr
Ste 5010
Issaquah, WA 98029
Phone (425) 394-0700

1401 Madison St
#100
Seattle, WA 98104
Phone (206) 386-6054

2450 33rd Ave W
Ste 100
Seattle, WA 98199
Phone (206) 320-3364

550 16th Ave
Ste 100
Seattle, WA 98122
Phone (206) 299-1900

747 Broadway
Seattle, WA 98122
Phone (360) 658-2488

800 5th Ave
Ste 600
Seattle, WA 98104

Interoperability endpoints

  • Direct secure messaging: ccanavera1041261@wm.providencedirect.org

Organizations & group practices 8

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.

Hospital & facility affiliations 5

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": "1161820800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602028800000",
    "number": "1639254576",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "275 W ROY ST",
            "address_2": "#410",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981194520",
            "telephone_number": "206-285-4857"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1601 5TH AVE",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981013621",
            "telephone_number": "206-623-7671"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "751 NE Blakely Dr Ste 5010",
            "address_purpose": "LOCATION",
            "city": "Issaquah",
            "state": "WA",
            "postal_code": "980296201",
            "country_code": "US",
            "telephone_number": "425-394-0700",
            "fax_number": "425-394-0757",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CANAVERA",
        "first_name": "COURTNEY",
        "middle_name": "ANNE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-26",
        "last_updated": "2020-10-07",
        "certification_date": "2020-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "MD00043403",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8394124",
            "state": "WA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ccanavera1041261@wm.providencedirect.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "751 NE Blakely Dr Ste 5010",
            "city": "Issaquah",
            "state": "WA",
            "country_code": "US",
            "postal_code": "980296201",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "COURTNEY",
            "last_name": "LANDO",
            "middle_name": "ANNE",
            "prefix": "DR.",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Seattle, WA

Sources for this page

Verify at the official NPI Registry.