Active NPI
Patrick T Phan, M.D.
- Psychiatry Physician
- Bellevue, WA
National Provider Identifier
1790962355
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- MD00026346
- Practice address
- 2902 112TH Ave SE
Bellevue, WA 98004-7528 - Phone
- (206) 725-4322
- NPI assigned
- Jan 25, 2008
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | MD00026346 | WA | Primary |
| General Practice Physician | 208D00000X | MD00026346 | WA |
Addresses
Primary practice location
2902 112TH Ave SE
Bellevue, WA 98004-7528
Mailing address
PO Box 649
Fort Defiance, AZ 86504-0649
Phone (928) 729-8000
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1029150 | Medicaid | WA |
Other names 1
- Dr. Tu Phan
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)
- Not enrolled
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD00026346 | WA | MD | Psychiatry Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| DHHS PHS Naihs Fort Defiance Hospital | 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.
-
- General Acute Care Hospital
- Fort Defiance, AZ
- NPI 1700962131
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1201219200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1412640000000",
"number": "1790962355",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 649",
"city": "FORT DEFIANCE",
"state": "AZ",
"postal_code": "865040649",
"telephone_number": "928-729-8000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2902 112TH AVE SE",
"city": "BELLEVUE",
"state": "WA",
"postal_code": "980047528",
"telephone_number": "206-725-4322"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHAN",
"first_name": "PATRICK",
"middle_name": "T",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-01-25",
"last_updated": "2014-10-07",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "WA",
"license": "MD00026346",
"primary": true
},
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "WA",
"license": "MD00026346",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1029150",
"state": "WA"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "TU",
"last_name": "PHAN",
"prefix": "DR.",
"credential": "M.D.",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Bellevue, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.