Individual provider Active NPI

Mark Derchuen Lo, M.D.

  • Pediatric Emergency Medicine (Pediatrics) Physician
  • Seattle, WA
National Provider Identifier
1649488123
Registry record updated May 31, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Emergency Medicine (Pediatrics) PhysicianTaxonomy code 2080P0204X
License
MD60095154 Issued in WA
Practice address
4800 Sand Point Way NE, M/S B5520
Seattle Children'S Hospital
Seattle, WA 98105
Phone
(206) 987-2599
NPI assigned
May 18, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 31, 2011

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X A99569 CA
Pediatric Emergency Medicine (Pediatrics) Physician 2080P0204X MD60095154 WA Primary

Addresses

Primary practice location

4800 Sand Point Way NE, M/S B5520
Seattle Children'S Hospital
Seattle, WA 98105

Mailing address

4800 Sand Point Way NE, M/S B5520
Seattle Children'S Hospital
Seattle, WA 98105
Phone (206) 987-2599

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
I20120904000470 WA Practitioner - Pediatric MedicinePractitioner - Emergency Medicine 6901053552 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A99569CAMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The Association of Chrmc and University Physicians Pediatrics CurrentSince Jul 1, 2014 Accepting new patients
Association of CHMC and University Physicians Pediatrics CurrentSince Jul 1, 2014 Accepting new patients

Locations

900 Pacific Ave
Ste 100
Everett, WA 98201
Phone (425) 304-6080

4800 Sand Point Way NE
#B5520
Seattle, WA 98105
Phone (206) 987-2380

4800 Sand Point Way NE
Seattle, WA 98105
Phone (206) 526-2000

Interoperability endpoints

  • Direct secure messaging: mlo27557@direct.seattlechildrens.org

Organizations & group practices 2

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": "1179446400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1306800000000",
    "number": "1649488123",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4800 SAND POINT WAY NE, M/S B5520",
            "address_2": "SEATTLE CHILDREN'S HOSPITAL",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "98105",
            "telephone_number": "206-987-2599"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4800 SAND POINT WAY NE, M/S B5520",
            "address_2": "SEATTLE CHILDREN'S HOSPITAL",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "98105",
            "telephone_number": "206-987-2599"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LO",
        "first_name": "MARK",
        "middle_name": "DERCHUEN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-18",
        "last_updated": "2011-05-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A99569",
            "primary": false
        },
        {
            "code": "2080P0204X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Emergency Medicine",
            "state": "WA",
            "license": "MD60095154",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Seattle, WA

Sources for this page

Verify at the official NPI Registry.