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Individual provider Active NPI

Laura Arvilla Hallak, MD

  • Family Medicine Physician
  • Aberdeen, WA
National Provider Identifier
1861609778
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
57010092 Issued in OH
Practice address
1921 Sumner Ave
Aberdeen, WA 98520-3606
Phone
(360) 538-0135
Fax
(360) 533-3475
NPI assigned
May 17, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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 57010092 OH Primary

Addresses

Primary practice location

1921 Sumner Ave
Aberdeen, WA 98520-3606

Mailing address

PO Box 1139
Aberdeen, WA 98520-0228
Phone (360) 538-0135

Other identifiers 2

IdentifierTypeStateIssuer
MD60014640OtherWAMEDICAL LICENSE
1126192MedicaidWA

Other names 1

  • Laura Arvilla Tamayo Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
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
I20080903000386 WA Practitioner - Family Practice 5193891877 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Grays Harbor Community HospitalGroup PAC ID 3577462365, 91 clinicians

Practice addresses (Care Compare)

815 K St
Hoquiam, WA 98550-3705
Phone (360) 537-6430

Hospital & facility affiliations

  • Harbors Home Health / Hospice Home health agency, Hoquiam, WA, CCN 507020
  • Assured Home Health and Hospice Home health agency, Centralia, WA, CCN 507042
  • Grays Harbor Community Hospital Hospital, Aberdeen, WA, CCN 500031
  • Summit Pacific Medical Center Hospital, Elma, WA, CCN 501304

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
57010092OHMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Grays Harbor Community Hospital Family Medicine CurrentSince Oct 1, 2011 Accepting new patients
Grays Harbor Community Hospital Current Accepting new patients
Grays Harbor House Hospitalist CurrentSince Jun 9, 2018 Accepting new patients
GHCH Physician Services, LLC Family Medicine CurrentSince Oct 1, 2011 Accepting new patients
Grays Harbor Community Hospital CurrentSince Jun 9, 2018 Accepting new patients
Nicholas Hallak, MD, PLLC Past Accepting new patients

Locations

915 Anderson Dr
Aberdeen, WA 98520
Phone (360) 532-8330

1921 Sumner Ave
Aberdeen, WA 98520
Phone (360) 533-6447

815 K St
Hoquiam, WA 98550
Phone (360) 533-2734

319 E Pioneer Ave
Montesano, WA 98563
Phone (360) 249-1980

Organizations & group practices 10

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 4

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": "1179360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1861609778",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1139",
            "city": "ABERDEEN",
            "state": "WA",
            "postal_code": "985200228",
            "telephone_number": "360-538-0135",
            "fax_number": "360-533-3475"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1921 SUMNER AVE",
            "city": "ABERDEEN",
            "state": "WA",
            "postal_code": "985203606",
            "telephone_number": "360-538-0135",
            "fax_number": "360-533-3475"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HALLAK",
        "first_name": "LAURA",
        "middle_name": "ARVILLA",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-05-17",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "57010092",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "MD60014640",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1126192",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LAURA",
            "last_name": "TAMAYO",
            "middle_name": "ARVILLA",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Aberdeen, WA

Sources for this page

Verify at the official NPI Registry.