Mara Hazeltine, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

MD61263356 Issued in WA

Practice address

62 W 7TH Ave Ste 320
Spokane, WA 99204-2321

Phone

(509) 381-6505

NPI assigned

Mar 21, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Specialty

Family Practice

Education

University of Washington School of Medicine, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Providence Health and Services Washington 778 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Prov Sacred HRT Med Ctr & Childs Hosp. Hospital, Spokane, WA, CCN 500054
• Providence St Luke'S Rehabilitation Medical Center Inpatient rehabilitation facility, Spokane, WA, CCN 503025

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• Providence Health & Services Washington

  • Pulmonary Disease Physician
  • Spokane, WA
  • NPI 1194099390

  Family Medicine, WA

  Medicare reassignment Care Compare group NPD
• Community Health Association of Spokane

  • Federally Qualified Health Center (FQHC)
  • Spokane, WA
  • NPI 1326005851

  WA

  Medicare reassignment NPD
• Providence Health & Services Washington

  • Rural Health Clinic/Center
  • Chewelah, WA
  • NPI 1639892672
  Care Compare group NPD
• Providence Health & Services Washington

  • Rural Health Clinic/Center
  • Colville, WA
  • NPI 1255685822
  Care Compare group
• Providence Health & Services Washington

  • Orthopaedic Surgery Physician
  • Spokane, WA
  • NPI 1376117325
  Care Compare group
• Providence Health & Services Washington

  • Rural Health Clinic/Center
  • Kettle Falls, WA
  • NPI 1538413109
  Care Compare group
• Providence Health & Services Washington

  • Orthopaedic Surgery Physician
  • Spokane Valley, WA
  • NPI 1710386818
  Care Compare group
• Providence Health & Services Washington

  • Orthopaedic Surgery Physician
  • Spokane, WA
  • NPI 1881059954
  Care Compare group
• Providence Health & Services Washington

  • Clinical Medical Laboratory
  • Spokane, WA
  • NPI 1902141500
  Care Compare group
• Community Health Association of Spokane

  • Federally Qualified Health Center (FQHC)
  • Spokane Valley, WA
  • NPI 1437526456
  NPD
• Community Health Association of Spokane

  • Federally Qualified Health Center (FQHC)
  • Spokane, WA
  • NPI 1679363592
  NPD
• Providence Health & Services - Washington

  • Substance Use Disorder Rehabilitation Hospital Unit
  • Hoquiam, WA
  • NPI 1043374119
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Providence Health & Services - Wa

  • General Acute Care Hospital
  • Spokane, WA
  • NPI 1144471715

  Hospital

  Care Compare affiliation
• Providence Health & Services- Washington

  • Rehabilitation Hospital
  • Spokane, WA
  • NPI 1497752091

  Inpatient rehabilitation facility

  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1553126400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721347200000",
    "number": "1689134181",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 421",
            "city": "LIBERTY LAKE",
            "state": "WA",
            "postal_code": "990190421",
            "telephone_number": "866-747-2455",
            "fax_number": "509-227-7070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "62 W 7TH AVE STE 320",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992042321",
            "telephone_number": "509-381-6505"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3919 N Maple St",
            "address_purpose": "LOCATION",
            "city": "Spokane",
            "state": "WA",
            "postal_code": "992051349",
            "country_code": "US",
            "telephone_number": "509-444-8200",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HAZELTINE",
        "first_name": "MARA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-03-21",
        "last_updated": "2024-07-19",
        "certification_date": "2024-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "MD61263356",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeffrey Hayward, PA-C
• Leslie Blevins Hayward, PSYCHOLOGIST
• Sarah Henn Hayward, P.T
• Dustin Haywood, LICSW
• Chadron B Hazelbaker, ATC, CSCS
• Gail Ann Heacox, RDH, BS
• Lia Stewart Head, M.D.
• Zachary Corey Headman, DO
• Headstrong NW PLLC
• Heal From Addiction, LLC

• All providers in Spokane, WA
• Family Medicine Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2024; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.