NPIMap

Individual provider Active NPI

Michael T. Kopec, M.D.

  • Family Medicine Physician
  • Seattle, WA
National Provider Identifier
1821225764
Registry record updated Jun 16, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD60277280 Issued in WA
Practice address
10521 Meridian Ave N
Seattle, WA 98133-9509
Phone
(206) 296-4990
Fax
(206) 205-5142
NPI assigned
Jun 18, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MD60277280 WA Primary

Addresses

Primary practice location

10521 Meridian Ave N
Seattle, WA 98133-9509

Mailing address

PO Box 3835
Seattle, WA 98124-3835
Phone (206) 548-3114

Other practice location 1

11603 State Ave Ste G
Marysville, WA 98271-8465
Phone (360) 658-6800

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mkopec308415@wm.providencedirect.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210813002357 VA Practitioner - Family Practice 2567610058 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Wayne State University School of Medicine, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

3640 High St
Suite 3B
Portsmouth, VA 23707-3213
Phone (757) 397-6344

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Evms Academic Physicians and Surgeons Health Services Foundation Family Medicine CurrentSince Oct 4, 2021 Accepting new patients

Locations

600 Gresham Dr
Norfolk, VA 23507
Phone (757) 473-0055

825 Fairfax Ave
Ste 310
Norfolk, VA 23507
Phone (757) 446-7900

3640 High St
Ste 3B
Portsmouth, VA 23707
Phone (757) 397-6344

Interoperability endpoints

  • Direct secure messaging: mkopec308415@wm.providencedirect.org

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.

Hospital & facility affiliations 12

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": "1245283200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623801600000",
    "number": "1821225764",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3835",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981243835",
            "telephone_number": "206-548-3114",
            "fax_number": "206-762-6355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10521 MERIDIAN AVE N",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981339509",
            "telephone_number": "206-296-4990",
            "fax_number": "206-205-5142"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11603 State Ave Ste G",
            "address_purpose": "LOCATION",
            "city": "Marysville",
            "state": "WA",
            "postal_code": "982718465",
            "country_code": "US",
            "telephone_number": "360-658-6800",
            "fax_number": "425-259-8600",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KOPEC",
        "first_name": "MICHAEL",
        "middle_name": "T.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-06-18",
        "last_updated": "2021-06-16",
        "certification_date": "2021-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "MD60277280",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mkopec308415@wm.providencedirect.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "11603 State Ave Ste G",
            "city": "Marysville",
            "state": "WA",
            "country_code": "US",
            "postal_code": "982718465",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Seattle, WA

Sources for this page

Verify at the official NPI Registry.