Active NPI
Thomas F Stark, MD
- Orthopaedic Surgery Physician
- Everett, WA
National Provider Identifier
1760422315
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthopaedic Surgery Physician
- License
- MD00042555
- Practice address
- 3726 Broadway
Suite 201
Everett, WA 98201-3787 - Phone
- (425) 317-9119
- NPI assigned
- Jun 8, 2006
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Orthopaedic Surgery Physician | 207X00000X | MD00042555 | WA | Primary |
Addresses
Primary practice location
3726 Broadway
Suite 201
Everett, WA 98201-3787
Mailing address
3726 Broadway
Suite 201
Everett, WA 98201-3787
Phone (425) 317-9119
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8360216 | Medicaid | WA | |
| P00048799 | Other | WA | RAILROAD MEDICARE |
| 0172186 | Other | WA | LABOR AND INDUSTRY |
| MD00042555 | Other | WA | STATE LICENSE NUMBER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD00042555 | WA | MD | Orthopaedic Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pueblo Orthopedic Professional Corporation | Orthopaedic Surgery | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Orthopaedic Surgery Physician
- Pueblo, CO
- NPI 1497780498
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149724800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1200182400000",
"number": "1760422315",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3726 BROADWAY",
"address_2": "SUITE 201",
"city": "EVERETT",
"state": "WA",
"postal_code": "982013787",
"telephone_number": "425-317-9119"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3726 BROADWAY",
"address_2": "SUITE 201",
"city": "EVERETT",
"state": "WA",
"postal_code": "982013787",
"telephone_number": "425-317-9119"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STARK",
"first_name": "THOMAS",
"middle_name": "F",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-08",
"last_updated": "2008-01-13",
"status": "A"
},
"taxonomies": [
{
"code": "207X00000X",
"taxonomy_group": "",
"desc": "Orthopaedic Surgery",
"state": "WA",
"license": "MD00042555",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8360216",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "P00048799",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LABOR AND INDUSTRY",
"identifier": "0172186",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE NUMBER",
"identifier": "MD00042555",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Everett, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.