NPIMap

Organization Active NPI

Overlake Medical Center & Clinics

  • Psychiatric Hospital Unit
  • Bellevue, WA
National Provider Identifier
1811904063
Registry record updated Aug 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric Hospital UnitTaxonomy code 273R00000X
Legal business name
OVERLAKE MEDICAL CENTER & CLINICS
Practice address
1035 116TH Ave NE
Bellevue, WA 98004-4604
Phone
(425) 688-5000
Fax
(425) 688-5658
NPI assigned
Aug 1, 2006
Last updated
Aug 4, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 4, 2025

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

Authorized official

Name
Jonathan Duarte
Title
Ceo
Phone
(425) 688-5784

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital Unit 273R00000X WA Primary

Addresses

Primary practice location

1035 116TH Ave NE
Bellevue, WA 98004-4604

Mailing address

1035 116TH Ave NE
Bellevue, WA 98004-4604
Phone (425) 688-5000

Other identifiers 2

IdentifierTypeStateIssuer
1019565MedicaidWA
50S051OtherWAMEDICARE PROVIDER NUMBER - INPATIENT PSYCH UNIT

Other names 1

  • Overlake Hospital Medical Center Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080129000323 WA Part A Provider - Hospital 9234023433 Practice locations: Bellevue, WA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1811904063. Details of each certification follow.

Hospital certification: CCN 50S051

Legal name
OVERLAKE MEDICAL CENTER & CLINICS
Organization structure
CorporationNon-profit
Incorporated
Feb 14, 1953 in WA
Enrollment address
1035 116TH Ave NE
Bellevue, WA 98004-4604
Hospital Psychiatric Unit
Hospital subgroups
Psychiatric unit

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
MMG Westgate Urgent Car99 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Member organizations 3

Organizations listed as members of this organization in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 17

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

NameRoleSinceShare
Benjamin Liu Individual Corporate Director Jan 1, 2025
Steve Schwartz Individual Corporate Director Jan 1, 2025
Patricia Bedient Individual Corporate OfficerTreasurer Jan 1, 2013
Eric R Shipley Individual Corporate Director Jan 1, 2024
Dilip Wagle Individual Corporate Director Jan 1, 2019
Denise Merle Individual Corporate Director Jan 1, 2025
Pauline Bach Individual Corporate Director Jan 1, 2023
Lisa Wissner-Slivka Individual Corporate Director Jan 1, 2019
Joel Robert Wilson Individual Corporate Director Jan 1, 2014
W-2 Managing Employee Jan 1, 2024
Kristina Belfiore Individual Corporate Director Jan 1, 2022
Ted Herb Individual Corporate Director Jan 1, 2016
Annette Clark Individual Corporate Director Jan 1, 2022
Multicare Health System Organization, Tacoma, WA Non-profit Operational/Managerial Control Oct 1, 2024 100%
James E Boswell Individual Corporate DirectorBoard Member Jan 1, 2024
W-2 Managing Employee Jan 1, 2024
Jonathan Thomas Duarte Individual Corporate OfficerCeo Oct 31, 2024
W-2 Managing EmployeeCeo Oct 31, 2024
Tiffany Koenig Individual Corporate Director Jan 1, 2020
Overlake Medical Center & Clinics Organization, Bellevue, WA Corporation 5% Or Greater Direct Ownership Interest Jan 1, 1966 100%

Owners & managing parties with NPI records 3

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Overlake Medical Center & ClinicsBellevue, WA, CCN 500051 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 1966

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 20

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

View all 20

Practitioners & affiliated clinicians

Practitioners 24

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 24

NPI Registry JSON

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

{
    "created_epoch": "1154390400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1754265600000",
    "number": "1811904063",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1035 116TH AVE NE",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980044604",
            "telephone_number": "425-688-5000",
            "fax_number": "425-688-5658"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1035 116TH AVE NE",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980044604",
            "telephone_number": "425-688-5000",
            "fax_number": "425-688-5658"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OVERLAKE MEDICAL CENTER & CLINICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-01",
        "last_updated": "2025-08-04",
        "certification_date": "2025-08-04",
        "status": "A",
        "authorized_official_last_name": "DUARTE",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "425-688-5784"
    },
    "taxonomies": [
        {
            "code": "273R00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Unit",
            "state": "WA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1019565",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PROVIDER NUMBER - INPATIENT PSYCH UNIT",
            "identifier": "50S051",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Overlake Hospital Medical Center",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Bellevue, WA

Sources for this page

Verify at the official NPI Registry.