Bonnie J. Witrak, MD

Primary specialty

Neuroradiology PhysicianTaxonomy code 2085N0700X

License

MD00022896 Issued in WA

Practice address

19020 33Rd Ave W Ste 210
Lynnwood, WA 98036-4748

Phone

(425) 563-1500

Fax

(425) 563-1501

NPI assigned

Jan 5, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Other identifiers 6

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

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.

• Everett Radia LLC

  • Diagnostic Radiology Physician
  • Everett, WA
  • NPI 1578550240
  NPD (past)
• Open MRI of Federal Way, L.L.C.

  • Radiology Clinic/Center
  • Federal Way, WA
  • NPI 1710980511
  NPD (past)
• Public Hospital District No 4, King County Wa

  • Family Medicine Physician
  • Snoqualmie, WA
  • NPI 1144432634
  NPD (past)
• Ramic Federal Way, LLC

  • Clinic/Center
  • Federal Way, WA
  • NPI 1073708400
  NPD (past)
• Swedish First Hill Diagnostic Imaging, LLC

  • Diagnostic Radiology Physician
  • Seattle, WA
  • NPI 1801938048
  NPD (past)
• Swedish Medical Center-Radia Issaquah Imaging Center LLC

  • Diagnostic Radiology Physician
  • Issaquah, WA
  • NPI 1427001312
  NPD (past)

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

{
    "created_epoch": "1136419200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1564963200000",
    "number": "1720066293",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19020 33RD AVE W STE 210",
            "city": "LYNNWOOD",
            "state": "WA",
            "postal_code": "980364748",
            "telephone_number": "425-563-1500",
            "fax_number": "425-563-1374"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19020 33RD AVE W STE 210",
            "city": "LYNNWOOD",
            "state": "WA",
            "postal_code": "980364748",
            "telephone_number": "425-563-1500",
            "fax_number": "425-563-1501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WITRAK",
        "first_name": "BONNIE",
        "middle_name": "J.",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-05",
        "last_updated": "2019-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085N0700X",
            "taxonomy_group": "",
            "desc": "Radiology, Neuroradiology",
            "state": "ID",
            "license": "M-12423",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "WA",
            "license": "MD00022896",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "ID",
            "license": "M-12423",
            "primary": false
        },
        {
            "code": "2085N0700X",
            "taxonomy_group": "",
            "desc": "Radiology, Neuroradiology",
            "state": "WA",
            "license": "MD00022896",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1720066293",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "L&I PROVIDER NUMBER",
            "identifier": "117424",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "L&I PROVIDER NUMBER",
            "identifier": "120220",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "L&I PROVIDER NUMBER",
            "identifier": "224089",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8131740",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "L&I PROVIDER NUMBER",
            "identifier": "204125",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michelle Lyn Wilson, LMT
• Pilar Wilson, OTR
• Reginald Wendell Wilson, M.D.
• Brandy Lee Wiltermuth, AP
• Victoria Winbow, DPT
• Adeyababa Fisseha Woldetensaye
• Kaileen Wolf
• Kathleen A Wolfe
• Matthew Justin Wolfe, MA
• Michael James Wollan

• Neuroradiology Physician in Lynnwood, WA
• Providers in Lynnwood, WA by specialty
• Neuroradiology Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.