Individual provider Active NPI

Roman Fedin, CDP

  • Mental Health Counselor
  • Spokane, WA
National Provider Identifier
1871143636
Registry record updated Nov 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
MC61024564 Issued in WA
Practice address
44 E Cozza Dr
Spokane, WA 99208-6514
Phone
(509) 325-6800
NPI assigned
Sep 13, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 9, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X CP60285814 WA
Mental Health Counselor 101YM0800X MC61024564 WA Primary

Addresses

Primary practice location

44 E Cozza Dr
Spokane, WA 99208-6514

Mailing address

4909 E 14TH Ave
Spokane Valley, WA 99212-3226
Phone (509) 342-5922

Other identifiers 1

IdentifierTypeStateIssuer
2077844MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240117000755 WA Practitioner - Mental Health Counselor 4587016431 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2017
Medicare assignment
May accept Medicare assignment
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

4909 E 14TH Ave
Spokane Valley, WA 99212-3226

PO Box
Suite 5299
Tacoma, WA 98415

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
CP60285814WAMDAddiction (Substance Use Disorder) Counselor
MC61024564WAMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Mens Counseling Center Mental Health CurrentSince Jul 16, 2023 Accepting new patients
Multicare Health System CurrentSince Jan 1, 2024 Accepting new patients
Multicare Health System CurrentSince Jan 1, 2024 Accepting new patients
Multicare Health System Current Accepting new patients

Locations

4700 Point Fosdick Dr
Ste 104
Gig Harbor, WA 98335
Phone (253) 459-7590

222 State Ave N
Kent, WA 98030
Phone (253) 372-7680

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1568332800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667952000000",
    "number": "1871143636",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4909 E 14TH AVE",
            "city": "SPOKANE VALLEY",
            "state": "WA",
            "postal_code": "992123226",
            "telephone_number": "509-342-5922"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "44 E COZZA DR",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992086514",
            "telephone_number": "509-325-6800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FEDIN",
        "first_name": "ROMAN",
        "credential": "CDP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-09-13",
        "last_updated": "2022-11-09",
        "certification_date": "2022-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WA",
            "license": "CP60285814",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "WA",
            "license": "MC61024564",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2077844",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Spokane, WA

Sources for this page

Verify at the official NPI Registry.