Active NPI
Fereshteh Momeni, M.D.
- Psychiatry Physician
- Medical Lake, WA
National Provider Identifier
1669454518
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- MD00040000
- Practice address
- 850 Maple Street
Medical Lake, WA 99022-0800 - Phone
- (509) 565-4000
- Fax
- (509) 565-4705
- NPI assigned
- Nov 16, 2005
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | MD00040000 | WA | Primary |
Addresses
Primary practice location
850 Maple Street
Medical Lake, WA 99022-0800
Mailing address
P.O. Box 800, 850 Maple Street
Medical Lake, WA 99022-0800
Phone (509) 565-4000
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8281818 | Medicaid | WA |
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
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Department of Social Dept of SHS Div of Instns | Psychiatry | Current | Accepting new patients |
| Eastern State Hospital Pharmacy | Past | Accepting new patients | |
| Department of Social | Past | Accepting new patients |
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.
-
dba Eastern State Hospital
- Psychiatric Hospital
- Medical Lake, WA
- NPI 1467440602
Psychiatry
-
- Long Term Care Pharmacy
- Medical Lake, WA
- NPI 1679651970
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1132099200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1432684800000",
"number": "1669454518",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "P.O. BOX 800, 850 MAPLE STREET",
"city": "MEDICAL LAKE",
"state": "WA",
"postal_code": "990220800",
"telephone_number": "509-565-4000",
"fax_number": "509-565-4705"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "850 MAPLE STREET",
"city": "MEDICAL LAKE",
"state": "WA",
"postal_code": "990220800",
"telephone_number": "509-565-4000",
"fax_number": "509-565-4705"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOMENI",
"first_name": "FERESHTEH",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-11-16",
"last_updated": "2015-05-27",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "WA",
"license": "MD00040000",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8281818",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Medical Lake, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.