Individual provider Active NPI

Kathleen Yanelli Moen, M.D.

  • Orthopaedic Surgery Physician
  • Seattle, WA
National Provider Identifier
1649206764
Registry record updated May 25, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License
10368 Issued in NH
Practice address
1101 Madison St
Suite 800
Seattle, WA 98104-1306
Phone
(206) 215-2700
Fax
(206) 215-2702
NPI assigned
Jun 23, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 25, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Orthopaedic Surgery Physician 207XP3100X MD60278954 WA
Orthopaedic Surgery Physician 207X00000X 10368 NH Primary

Addresses

Primary practice location

1101 Madison St
Suite 800
Seattle, WA 98104-1306

Mailing address

1101 Madison St
Suite 800
Seattle, WA 98104-1306
Phone (206) 215-2700

Other practice location 1

751 NE Blakely Dr Ste 5010
Issaquah, WA 98029-6201
Phone (206) 215-2700

Other identifiers 2

IdentifierTypeStateIssuer
30011560MedicaidNH
0RE4880MedicaidVT

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address kmoen1042558@wm.providencedirect.org Direct
Direct Messaging Address kmoen1042558@wm.providencedirect.org Direct

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
I20120803000796 WA Practitioner - Orthopedic SurgeryPractitioner - Pediatric Medicine 2466463914 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Swedish Health Services Orthopaedic Surgery CurrentSince Jul 1, 2012 Accepting new patients

Locations

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

800 5th Ave
Ste 600
Seattle, WA 98104

1101 Madison St
Ste 800
Seattle, WA 98104

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

Interoperability endpoints

  • Direct secure messaging: kmoen1042558@wm.providencedirect.org

Organizations & group practices 1

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": "1151020800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621900800000",
    "number": "1649206764",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1101 MADISON ST",
            "address_2": "SUITE 800",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981041306",
            "telephone_number": "206-215-2700",
            "fax_number": "206-215-2702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 MADISON ST",
            "address_2": "SUITE 800",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981041306",
            "telephone_number": "206-215-2700",
            "fax_number": "206-215-2702"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "751 NE Blakely Dr Ste 5010",
            "address_purpose": "LOCATION",
            "city": "Issaquah",
            "state": "WA",
            "postal_code": "980296201",
            "country_code": "US",
            "telephone_number": "206-215-2700",
            "fax_number": "206-215-2702",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOEN",
        "first_name": "KATHLEEN",
        "middle_name": "YANELLI",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-23",
        "last_updated": "2021-05-25",
        "certification_date": "2021-05-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207XP3100X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Pediatric Orthopaedic Surgery",
            "state": "WA",
            "license": "MD60278954",
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "NH",
            "license": "10368",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30011560",
            "state": "NH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0RE4880",
            "state": "VT"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kmoen1042558@wm.providencedirect.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1101 Madison St",
            "address_2": "suite 800",
            "city": "Seattle",
            "state": "WA",
            "country_code": "US",
            "postal_code": "981041306",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kmoen1042558@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": []
}

Other providers in Seattle, WA

Sources for this page

Verify at the official NPI Registry.