Jack Mark Fishaut, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

MD00040965 Issued in WA

Practice address

235 Blair Ave
Friday Harbor, WA 98250-0796

Phone

(360) 370-5971

Fax

(360) 370-5980

NPI assigned

Dec 1, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 10

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Aurora Community Health PLLC

  • Family Nurse Practitioner
  • Friday Harbor, WA
  • NPI 1821867961
  NPD
• Friday Harbor Family Clinic PLLC

  • Clinic/Center
  • Friday Harbor, WA
  • NPI 1861143398
  NPD
• San Juan Healthcare Associates PLLC

  • Rural Health Clinic/Center
  • Friday Harbor, WA
  • NPI 1356326565
  NPD (past)

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

{
    "created_epoch": "1133395200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1891779195",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 796",
            "city": "FRIDAY HARBOR",
            "state": "WA",
            "postal_code": "982500796",
            "telephone_number": "360-370-5971",
            "fax_number": "360-370-5980"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "235 BLAIR AVE",
            "city": "FRIDAY HARBOR",
            "state": "WA",
            "postal_code": "982500796",
            "telephone_number": "360-370-5971",
            "fax_number": "360-370-5980"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FISHAUT",
        "first_name": "JACK",
        "middle_name": "MARK",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-01",
        "last_updated": "2023-03-07",
        "certification_date": "2022-02-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "WA",
            "license": "MD00040965",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PARK NATL L & L",
            "identifier": "361929500",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP HEALTH",
            "identifier": "532300004",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE BLUE SHIELD",
            "identifier": "4952FI",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNIFORM",
            "identifier": "912109329",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHPW",
            "identifier": "912109329",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREMERA BLUE CROSS",
            "identifier": "912109329",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "0182789",
            "identifier": "LABOR AND INDUSTRIES",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DSHS MEDICAID",
            "identifier": "8387367",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRST CHOICE",
            "identifier": "912109329",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CRIME VICTIMS",
            "identifier": "8930937",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• J. Michael Edwards, M.D., D.D.S.
• Ellen Roberts Counseling, PC
• Eventide Health PLLC
• Ingrid Susanne Fabianson, MSW, M.DIV.
• Quinn N Fihn, PMHNP-BC
• Kristina M Fisher, OTR/L
• Mark David Fleming, D.D.S.
• Peter Michael Forlenza
• Ruth Kay Fothergill, M.D,
• Four Winds Therapy

• Pediatrics Physician in Friday Harbor, WA
• Providers in Friday Harbor, WA by specialty
• Pediatrics Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.