Organization Active NPI

Fremont Family Practice LLC

  • Family Medicine Physician
  • Seattle, WA
National Provider Identifier
1871640581
Registry record updated Aug 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
602228609 Issued in WA
Legal business name
FREMONT FAMILY PRACTICE LLC
Practice address
6804 Greenwood Ave N
Seattle, WA 98103-5228
Phone
(206) 257-7380
NPI assigned
Jan 4, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 9, 2022

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

Authorized official

Name
David HarveyNPI 1427169911
Title
Medical Doctor
Phone
(206) 257-7380

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X 602228609 WA Primary

Addresses

Primary practice location

6804 Greenwood Ave N
Seattle, WA 98103-5228

Mailing address

4464 Fremont Ave N
Suite 103
Seattle, WA 98103-7273

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040402000762 WA Part B Supplier - Clinic/Group Practice 4981696382 Receives reassigned benefits from 11 practitioners
Practice locations: Seattle, WA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
50D1006765Fremont Family Practice, LLC6804 Greenwood Ave N, Seattle, WA 98103Provider-performed microscopyApr 4, 2028

National Provider Directory

National Provider Directory

Locations

4464 Fremont Ave N
Ste 103
Seattle, WA 98103
Phone (206) 267-7300

6804 Greenwood Ave N
Seattle, WA 98103
Phone (206) 257-7780

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1167868800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660003200000",
    "number": "1871640581",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4464 FREMONT AVE N",
            "address_2": "SUITE 103",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981037273"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6804 GREENWOOD AVE N",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981035228",
            "telephone_number": "206-257-7380"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FREMONT FAMILY PRACTICE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-04",
        "last_updated": "2022-08-09",
        "certification_date": "2022-08-09",
        "status": "A",
        "authorized_official_last_name": "HARVEY",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "MEDICAL DOCTOR",
        "authorized_official_telephone_number": "206-257-7380"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "602228609",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Seattle, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.