Individual provider Active NPI

Jaclyn Mahlstede, ARNP

  • Family Nurse Practitioner
  • Bellevue, WA
National Provider Identifier
1659610764
Registry record updated May 14, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
AP60820546 Issued in WA
Practice address
1135-116TH Avenue NE
Suite 200
Bellevue, WA 98004
Phone
(520) 324-2160
Fax
(520) 324-1460
NPI assigned
Feb 8, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 14, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 60820546 WA
Family Nurse Practitioner 363LF0000X AP60820546 WA Primary

Addresses

Primary practice location

1135-116TH Avenue NE
Suite 200
Bellevue, WA 98004

Mailing address

Ms 315010
PO Box 3947
Seattle, WA 98124-3947
Phone (425) 467-3655

Other identifiers 2

IdentifierTypeStateIssuer
2145072MedicaidWA
791187MedicaidAZ

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180605003491 WA Practitioner - Nurse Practitioner 0941455224 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Overlake Medical Clinics LLCGroup PAC ID 7012808827, 423 clinicians

Practice addresses (Care Compare)

1231 116TH Ave NE
Bellevue, WA 98004-3804

1750 112TH Ave NE
Suite B102
Bellevue, WA 98004-3772
Phone (425) 688-5460

22630 SE 4TH St
Suite 300
Sammamish, WA 98074-7131
Phone (425) 635-3070

5708 E Lake Samm Pkwy SE
Issaquah, WA 98029-8942
Phone (425) 688-5488

619 156TH Ave SE
Bellevue, WA 98007-5328
Phone (425) 637-3270

Hospital & facility affiliations

  • Overlake Hospital Medical Center & Clinics Hospital, Bellevue, WA, CCN 500051

Merit-based Incentive Payment System (MIPS)

Final score
86.73 of 100Reported as apm
Quality
73.46
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
60820546WAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Overlake Medical Clinics, LLC CurrentSince May 17, 2020 Accepting new patients
Overlake Medical Clinics LLC CurrentSince May 21, 2018 Accepting new patients
Issaquah Obstetrics and Gynecology PLLC Past Accepting new patients

Locations

1750 112th Ave NE
Ste B102
Bellevue, WA 98004
Phone (425) 688-5460

1035 116th Ave NE
Bellevue, WA 98004
Phone (425) 451-4141

5708 E Lake Sammamish Pkwy SE
Ste 101
Issaquah, WA 98029

6520 226th Pl SE
Ste 150
Issaquah, WA 98027
Phone (425) 688-5777

13159 Newcastle Commons Dr
Newcastle, WA 98059
Phone (425) 635-3010

Interoperability endpoints

  • Direct secure messaging: jaclyn.mahlstede.1@19198.direct.athenahealth.com

Organizations & group practices 3

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.

Hospital & facility affiliations 2

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": "1360281600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1589414400000",
    "number": "1659610764",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "MS 315010",
            "address_2": "PO BOX 3947",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981243947",
            "telephone_number": "425-467-3655",
            "fax_number": "425-835-6388"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1135-116TH AVENUE NE",
            "address_2": "SUITE 200",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "98004",
            "telephone_number": "520-324-2160",
            "fax_number": "520-324-1460"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAHLSTEDE",
        "first_name": "JACLYN",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-02-08",
        "last_updated": "2020-05-14",
        "certification_date": "2020-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WA",
            "license": "60820546",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WA",
            "license": "AP60820546",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2145072",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "791187",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bellevue, WA

Sources for this page

Verify at the official NPI Registry.