NPIMap

Organization Active NPI

Sea Mar Community Health Centers

  • Federally Qualified Health Center (FQHC)
  • Vashon, WA
National Provider Identifier
1760080154
Registry record updated Feb 26, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
SEA MAR COMMUNITY HEALTH CENTERS
Practice address
10030 SW 210TH St
Vashon, WA 98070-6584
Phone
(206) 463-3671
Fax
(206) 463-3613
NPI assigned
Oct 16, 2020
Last updated
Feb 26, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 26, 2025

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

Authorized official

Name
Mary Bartolo
Title
Executive Vice President
Phone
(206) 763-5277

Specialties & licenses 15

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X
Addiction (Substance Use Disorder) Counselor 101YA0400X
Family Medicine Physician 207Q00000X
Adolescent Medicine (Family Medicine) Physician 207QA0000X
Adult Medicine Physician 207QA0505X
Sports Medicine (Family Medicine) Physician 207QS0010X
Internal Medicine Physician 207R00000X
Cardiovascular Disease Physician 207RC0000X
Endocrinology, Diabetes & Metabolism Physician 207RE0101X
Geriatric Medicine (Internal Medicine) Physician 207RG0300X
Nephrology Physician 207RN0300X
Obstetrics & Gynecology Physician 207V00000X
Psychiatry Physician 2084P0800X
Child & Adolescent Psychiatry Physician 2084P0804X
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

10030 SW 210TH St
Vashon, WA 98070-6584

Mailing address

PO Box 34703
Seattle, WA 98124-1703

Other identifiers 1

IdentifierTypeStateIssuer
2165780MedicaidWA

Other names 2

  • Sea-Mar Community Health Center Former legal business name
  • Sea Mar CHC Vashon Medical Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040211001210 WA Part B Supplier - Clinic/Group Practice 7315831161 Receives reassigned benefits from 551 practitioners
41 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Mount Vernon, WA; Ocean Shores, WA; Olympia, WA; Puyallup, WA; Seattle, WA; Spanaway, WA; Everett, WA; Tacoma, WA…
O20201111002840 WA Part A Provider - Federally Qualified Health Center (FQHC) 7315831161 Practice locations: Vashon, WA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1760080154. Details of each certification follow.

Federally qualified health center certification: CCN 941082

Legal name
SEA MAR COMMUNITY HEALTH CENTERS
Doing business as
SEA MAR CHC-VASHON ISLAND
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 20, 2020
Last certification
Oct 20, 2020
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Apr 14, 1977 in WA
Enrollment address
10030 SW 210TH St
Vashon, WA 98070-6584

Other NPIs on the same Medicare enrollment 41

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 41

National Provider Directory

National Provider Directory

Locations

9650 15th Ave SW
Seattle, WA 98106
Phone (206) 965-1000

Ownership & related parties

All disclosed owners & managing parties 13

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Juan Enrique Garza Individual Corporate Director Aug 6, 2024 9%
Daniela Diaz de la Vega Gonzales Individual Corporate DirectorPatient Representative, Homeless Jun 6, 2023 9%
Mary Bartolo Individual Corporate OfficerExecutive Vice President Jun 1, 1978
W-2 Managing EmployeeExecutive Vice President Jun 1, 1978
Agustin Delgado Individual Corporate DirectorVice Chair Mar 13, 2013 9%
Kristina Kathleen Hoeschen Individual W-2 Managing EmployeeChief Compliance Officer May 1, 2017
Ricardo Gasca Individual Corporate DirectorVice Chair Oct 16, 2016 9%
Gregory J Ma Individual Corporate DirectorChair Sep 1, 1982 9%
Bertha Michelle Danley Individual Corporate DirectorQuality Improvement Chair Nov 1, 2001 9%
Felipe Trinidad-Martinez Individual Corporate DirectorMigrant Representative May 8, 2008 9%
Erasmo Gamboa Individual Corporate DirectorTreasurer Apr 10, 2010 9%
Rogelio Riojas Individual Corporate OfficerPresident, Ceo Apr 1, 1978
Sea Mar Community Health Centers Organization, Seattle, WA Non-profit 5% Or Greater Direct Ownership Interest Jul 19, 1978 100%
Silverio Vivanco-Sanchez Individual Corporate DirectorMigrant Representative May 8, 2008 9%

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Sea Mar Community Health CentersSpanaway, WA, CCN 941095 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jul 19, 1978

Facilities with the same owner 1

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1602806400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1740528000000",
    "number": "1760080154",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 34703",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981241703"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10030 SW 210TH ST",
            "city": "VASHON",
            "state": "WA",
            "postal_code": "980706584",
            "telephone_number": "206-463-3671",
            "fax_number": "206-463-3613"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SEA MAR COMMUNITY HEALTH CENTERS",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-16",
        "last_updated": "2025-02-26",
        "certification_date": "2025-02-26",
        "status": "A",
        "authorized_official_last_name": "BARTOLO",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "EXECUTIVE VICE PRESIDENT",
        "authorized_official_telephone_number": "206-763-5277"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207QA0000X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adolescent Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207QA0505X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adult Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2165780",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sea-Mar Community Health Center",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Sea Mar CHC Vashon Medical",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Vashon, WA

Sources for this page

Verify at the official NPI Registry.