Individual provider Active NPI

Perry D Mostov, DO

  • Family Medicine Physician
  • Bainbridge Island, WA
National Provider Identifier
1831152198
Registry record updated Jun 18, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
OP60744283 Issued in WA
Practice address
1344 Wintergreen LN NE
Bainbridge Island, WA 98110
Phone
(206) 842-5632
Fax
(206) 842-5992
NPI assigned
Apr 8, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 18, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 34004921 OH
Family Medicine Physician 207Q00000X OP60744283 WA Primary

Addresses

Primary practice location

1344 Wintergreen LN NE
Bainbridge Island, WA 98110

Mailing address

1344 Wintergreen LN NE
Bainbridge Island, WA 98110-5118
Phone (206) 842-5632

Other practice location 1

6515 Pullman Dr
Suite 2200
Lewis Center, OH 43035-7380
Phone (614) 688-7150

Other practice location 2

380 Winslow Way E
Bainbridge Island, WA 98110-2424
Phone (206) 842-5631

Other identifiers 1

IdentifierTypeStateIssuer
0950734MedicaidOH

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
I20170613002573 WA Practitioner - Family Practice 0840184016 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Ohio University, College of Osteopathic Medicine, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Virginia Mason Medical CenterGroup PAC ID 9830002617, 867 clinicians

Practice addresses (Care Compare)

1344 Wintergreen LN NE
Bainbridge Island, WA 98110-5118
Phone (206) 842-5632

Hospital & facility affiliations

  • CHI Franciscan Health at Home Home health agency, University Place, WA, CCN 507124
  • Virginia Mason Medical Center Hospital, Seattle, WA, CCN 500005
  • St Michael Medical Center Hospital, Silverdale, WA, CCN 500039
  • Jefferson Healthcare Hospital, Port Townsend, WA, CCN 501323

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
34004921OHMDFamily Medicine Physician
OP60744283WAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Virginia Mason Medical Center Current Accepting new patients
Virginia Mason Medical Center CurrentSince Jun 8, 2017 Accepting new patients
Osu Family Practice Services Family Medicine Current Accepting new patients
Virginia Mason Medical Center CurrentSince Jun 8, 2017 Accepting new patients
Virginia Mason Medical Center Family Medicine Current Accepting new patients
Virginia Mason Medical Center Past Accepting new patients

Locations

543 Taylor Ave
Fl 2
Columbus, OH 43203
Phone (614) 293-2700

2231 N High St
Columbus, OH 43201
Phone (614) 293-2700

6515 Pullman Dr
Ste 2200
Lewis Center, OH 43035
Phone (614) 688-7076

445 E Granville Rd
Worthington, OH 43085
Phone (614) 293-9450

380 Winslow Way E
Bainbridge Island, WA 98110
Phone (206) 842-5632

1344 Wintergreen Ln NE
Bainbridge Island, WA 98110
Phone (206) 842-5632

380 Winslow Way E
#A
Bainbridge Island, WA 98110

925 Seneca St
Seattle, WA 98101
Phone (206) 341-0860

4575 Sand Point Way NE
Ste 108
Seattle, WA 98105
Phone (206) 525-8000

1100 9th Ave
Seattle, WA 98101
Phone (206) 223-6980

Interoperability endpoints

  • FHIR API: https://fhir-myrecord.cerner.com/r4/66ad9a50-d7f7-4c21-b933-2ba90047388e/

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 6

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": "1144454400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1529280000000",
    "number": "1831152198",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1344 WINTERGREEN LN NE",
            "city": "BAINBRIDGE ISLAND",
            "state": "WA",
            "postal_code": "981105118",
            "telephone_number": "206-842-5632",
            "fax_number": "206-842-5992"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1344 WINTERGREEN LN NE",
            "city": "BAINBRIDGE ISLAND",
            "state": "WA",
            "postal_code": "98110",
            "telephone_number": "206-842-5632",
            "fax_number": "206-842-5992"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6515 Pullman Dr",
            "address_2": "SUITE 2200",
            "address_purpose": "LOCATION",
            "city": "Lewis Center",
            "state": "OH",
            "postal_code": "430357380",
            "country_code": "US",
            "telephone_number": "614-688-7150",
            "fax_number": "614-688-7155",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "380 Winslow Way E",
            "address_purpose": "LOCATION",
            "city": "Bainbridge Island",
            "state": "WA",
            "postal_code": "981102424",
            "country_code": "US",
            "telephone_number": "206-842-5631",
            "fax_number": "206-842-5992",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOSTOV",
        "first_name": "PERRY",
        "middle_name": "D",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-08",
        "last_updated": "2018-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "34004921",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "OP60744283",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0950734",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bainbridge Island, WA

Sources for this page

Verify at the official NPI Registry.