NPIMap

Organization Active NPI

North Pacific Dermatology PS

  • Ambulatory Surgical Clinic/Center
  • Renton, WA
National Provider Identifier
1881845907
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
Legal business name
NORTH PACIFIC DERMATOLOGY PS
Practice address
1412 SW 43Rd St
Ste 205
Renton, WA 98057-4803
Phone
(425) 264-0660
Fax
(425) 264-0601
NPI assigned
Oct 7, 2008
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Dr. Nobuyoshi Kageyama, MDNPI 1679561427
Title
Secretary/Treasurer
Phone
(425) 264-0660

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
Ambulatory Surgical Clinic/Center 261QA1903X Primary

Addresses

Primary practice location

1412 SW 43Rd St
Ste 205
Renton, WA 98057-4803

Mailing address

1200 112TH Ave NE
Ste C187
Bellevue, WA 98004-3732
Phone (425) 457-7900

Other practice location 1

1200 112th Ave NE Ste C187
Bellevue, WA 98004-3749
Phone (425) 457-7900

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20081031000236 WA Part B Supplier - Ambulatory Surgical Center 2264448059 Receives reassigned benefits from 27 practitioners
Practice locations: Bellevue, WA

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
North Pacific Dermatology PSCCN 50C0001286
Medicare certification status
ActiveFrom the Provider of Services file

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
50D1085511North Pacific Dermatology, PS1200 112TH Ave NE Ste C-187, Bellevue, WA 98004ComplianceApr 4, 2028

National Provider Directory

National Provider Directory

Locations

4509 Talbot Rd S
Ste 101
Renton, WA 98055
Phone (425) 228-4520

4740 44th Ave SW
Seattle, WA 98116
Phone (206) 932-0070

Practitioners & affiliated clinicians

Practitioners 31

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 31

NPI Registry JSON

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

{
    "created_epoch": "1223337600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1881845907",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 112TH AVE NE",
            "address_2": "STE C187",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980043732",
            "telephone_number": "425-457-7900",
            "fax_number": "425-264-0601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1412 SW 43RD ST",
            "address_2": "STE 205",
            "city": "RENTON",
            "state": "WA",
            "postal_code": "980574803",
            "telephone_number": "425-264-0660",
            "fax_number": "425-264-0601"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1200 112th Ave NE Ste C187",
            "address_purpose": "LOCATION",
            "city": "Bellevue",
            "state": "WA",
            "postal_code": "980043749",
            "country_code": "US",
            "telephone_number": "425-457-7900",
            "fax_number": "425-264-0601",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "NORTH PACIFIC DERMATOLOGY PS",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-07",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "KAGEYAMA",
        "authorized_official_first_name": "NOBUYOSHI",
        "authorized_official_title_or_position": "SECRETARY/TREASURER",
        "authorized_official_telephone_number": "425-264-0660",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Renton, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 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.