NPIMap

Individual provider Active NPI

Archana Madhuri Rajan, M.D

  • Family Medicine Physician
  • Bonney Lake, WA
National Provider Identifier
1649621806
Registry record updated Dec 9, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD60900975 Issued in WA
Practice address
9230 Sky Island Dr E
Bonney Lake, WA 98391-7385
Phone
(253) 750-6000
Fax
(253) 426-6344
NPI assigned
Jun 28, 2016
Last updated
Dec 9, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 9, 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 MD60900975 WA Primary

Addresses

Primary practice location

9230 Sky Island Dr E
Bonney Lake, WA 98391-7385

Mailing address

9230 Sky Island Dr E
Bonney Lake, WA 98391-7385
Phone (253) 750-6000

Other identifiers 1

IdentifierTypeStateIssuer
2141661MedicaidWA

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address arajan514023@fhsce.catholichealth.net 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
I20191107001709 WA Practitioner - Family Practice 7618227067 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Franciscan Medical GroupGroup PAC ID 0547173866, 1,400 clinicians

Practice addresses (Care Compare)

9230 Sky Island Dr E
FL 1
Bonney Lake, WA 98391-7385
Phone (253) 750-6022

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD60900975WAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Franciscan Medical Group Current Accepting new patients
Franciscan Medical Group Family Medicine CurrentSince Sep 15, 2019 Accepting new patients
Franciscan Medical Group CurrentSince Sep 15, 2019 Accepting new patients
Franciscan Medical Group Family Medicine Past Accepting new patients

Locations

9230 Sky Island Dr E
Bonney Lake, WA 98391
Phone (253) 750-6000

9230 Sky Island Dr E
Fl 1
Bonney Lake, WA 98391
Phone (253) 750-6000

1812 S J St
Ste 120
Tacoma, WA 98405
Phone (253) 428-2200

Interoperability endpoints

  • Direct secure messaging: arajan514023@fhsce.catholichealth.net

Organizations & group practices 4

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 7

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": "1467072000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607472000000",
    "number": "1649621806",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9230 SKY ISLAND DR E",
            "city": "BONNEY LAKE",
            "state": "WA",
            "postal_code": "983917385",
            "telephone_number": "253-750-6000",
            "fax_number": "253-426-6344"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9230 SKY ISLAND DR E",
            "city": "BONNEY LAKE",
            "state": "WA",
            "postal_code": "983917385",
            "telephone_number": "253-750-6000",
            "fax_number": "253-426-6344"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAJAN",
        "first_name": "ARCHANA",
        "middle_name": "MADHURI",
        "name_prefix": "Dr.",
        "credential": "M.D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-06-28",
        "last_updated": "2020-12-09",
        "certification_date": "2020-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "MD60900975",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2141661",
            "state": "WA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "arajan514023@fhsce.catholichealth.net",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "9230 Sky Island Dr E",
            "city": "Bonney Lake",
            "state": "WA",
            "country_code": "US",
            "postal_code": "983917385",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Bonney Lake, WA

Sources for this page

Verify at the official NPI Registry.