Individual provider Active NPI

Stella C Tanedo, MD

  • Internal Medicine Physician
  • Everett, WA
National Provider Identifier
1790790582
Registry record updated Apr 7, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD60130480 Issued in WA
Practice address
12800 Bothell Everett Hwy
Suite 180
Everett, WA 98208-6642
Phone
(425) 316-5130
Fax
(425) 225-1004
NPI assigned
Jul 30, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 7, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X G79170 CA
Internal Medicine Physician 207R00000X MD60130480 WA Primary

Addresses

Primary practice location

12800 Bothell Everett Hwy
Suite 180
Everett, WA 98208-6642

Mailing address

PO Box 3360
Portland, OR 97208-3360
Phone (866) 366-2983

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address stanedo122157@wm.providencedirect.org

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100325000711 WA Practitioner - Internal Medicine 0648162545 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Illinois College of Med (CHI/Peor/Rock/CHM-Urb), 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Select Outpatient Services IncGroup PAC ID 4082868815, 750 clinicians
Select Rehabilitation, LLCGroup PAC ID 9032020490, 1,935 clinicians

Practice addresses (Care Compare)

12800 Bothell Everett Hwy
Everett, WA 98208-6644

2600 Compass Rd
Glenview, IL 60026-8001

4112 Harbour Pointe Blvd SW
Suite 100
Mukilteo, WA 98275-5457
Phone (425) 347-6330

Hospital & facility affiliations

  • Providence at Home With Compassus, Snohomish County Home health agency, Everett, WA, CCN 507065
  • Assured Home Health Home health agency, Mountlake Terrace, WA, CCN 507099
  • Evergreenhealth Home Care Services Home health agency, Kirkland, WA, CCN 507079
  • Providence Regional Medical Center Everett Hospital, Everett, WA, CCN 500014
  • Swedish Edmonds Hospital Hospital, Edmonds, WA, CCN 500026

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
G79170CAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Health & Services - Wa CurrentSince Mar 1, 2010 Accepting new patients
Providence Health & Services- Washington CurrentSince Mar 1, 2010 Accepting new patients
Providence Facey Medical Foundation Past Accepting new patients
Providence Facey Medical Foundation Past Accepting new patients
Providence Health & Services - Washington Past Accepting new patients

Locations

1321 Colby Ave
Ofc
Everett, WA 98201
Phone (425) 261-4076

12800 Bothell Everett Hwy
Everett, WA 98208
Phone (425) 316-5060

12800 Bothell Everett Hwy
Ste 180
Everett, WA 98208
Phone (425) 316-5130

4112 Harbour Pointe Blvd SW
Ste 100
Mukilteo, WA 98275
Phone (425) 347-6330

Interoperability endpoints

  • Direct secure messaging: stanedo122157@wm.providencedirect.org

Organizations & group practices 6

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.

Hospital & facility affiliations 7

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

NPI Registry JSON

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

{
    "created_epoch": "1154217600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617753600000",
    "number": "1790790582",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3360",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972083360",
            "telephone_number": "866-366-2983"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12800 BOTHELL EVERETT HWY",
            "address_2": "SUITE 180",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982086642",
            "telephone_number": "425-316-5130",
            "fax_number": "425-225-1004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TANEDO",
        "first_name": "STELLA",
        "middle_name": "C",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-30",
        "last_updated": "2021-04-07",
        "certification_date": "2021-04-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "G79170",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WA",
            "license": "MD60130480",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "stanedo122157@wm.providencedirect.org",
            "affiliation": "N",
            "address_1": "12800 Bothell Everett Hwy",
            "address_2": "Suite 180",
            "city": "Everett",
            "state": "WA",
            "country_code": "US",
            "postal_code": "982086642",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Everett, WA

Sources for this page

Verify at the official NPI Registry.