NPIMap

Organization Active NPI

Sea Mar Community Health Centers

  • Federally Qualified Health Center (FQHC)
  • Puyallup, WA
National Provider Identifier
1912055286
Registry record updated Aug 27, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
6005372781 Issued in WA
Legal business name
SEA MAR COMMUNITY HEALTH CENTERS
Practice address
10217 125TH Street CT E FL 2
Puyallup, WA 98374-2761
Phone
(253) 864-4550
Fax
(253) 864-4558
NPI assigned
Jan 5, 2007
Last updated
Aug 27, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 27, 2026

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

Authorized official

Name
Mary Bartolo
Title
Executive Vice President
Phone
(206) 763-5277

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Registered DietitianGroup: 193200000X MULTI-SPECIALTY GROUP 133V00000X
Case Manager/Care CoordinatorGroup: 193200000X MULTI-SPECIALTY GROUP 171M00000X
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
Federally Qualified Health Center (FQHC) 261QF0400X 6005372781 WA Primary

Addresses

Primary practice location

10217 125TH Street CT E FL 2
Puyallup, WA 98374-2761

Mailing address

PO Box 34703
Seattle, WA 98124-1703

Other identifiers 3

IdentifierTypeStateIssuer
7104466MedicaidWA
7123813MedicaidWA
1021994MedicaidWA

Other names 2

  • Sea-Mar Community Health Center Former legal business name
  • Sea Mar CHC Puyallup Medical Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040211001210 WA Part B Supplier - Clinic/Group Practice 7315831161 Receives reassigned benefits from 551 practitioners
41 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Mount Vernon, WA; Ocean Shores, WA; Olympia, WA; Puyallup, WA; Seattle, WA; Spanaway, WA; Everett, WA; Tacoma, WA…
O20040520000326 WA Part A Provider - Federally Qualified Health Center (FQHC) 7315831161 Practice locations: Puyallup, WA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1912055286. Details of each certification follow.

Federally qualified health center certification: CCN 501881

Legal name
SEA MAR COMMUNITY HEALTH CENTERS
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 28, 2004
Last certification
Jun 28, 2004
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Dec 11, 2006 in WA
Enrollment address
10217 125TH Street CT E
Puyallup, WA 98374-2761

Other NPIs on the same Medicare enrollment 41

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 41

National Provider Directory

National Provider Directory

Locations

8720 14th Ave S
Seattle, WA 98108
Phone (206) 762-3730

Ownership & related parties

All disclosed owners & managing parties 11

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Daniela Diaz de la Vega Gonzales Individual Corporate DirectorBoard Member Jun 6, 2023
Mary Bartolo Individual Corporate OfficerExecutive Vice President Apr 17, 1978
W-2 Managing EmployeeExecutive Vice President Apr 17, 1978
Agustin Delgado Individual Corporate DirectorBoard Member Mar 13, 2013
Kristina Kathleen Hoeschen Individual W-2 Managing EmployeeChief Compliance Officer May 1, 2017
Ricardo Gasca Individual Corporate DirectorBoard Member Oct 16, 2016
Gregory J Ma Individual Corporate DirectorBoard Member Sep 1, 1982
Bertha Michelle Danley Individual Corporate DirectorBoard Member Nov 1, 2001
Felipe Trinidad-Martinez Individual Corporate DirectorBoard Member May 1, 2008
Erasmo Gamboa Individual Corporate DirectorBoard Member Apr 10, 2010
Rogelio Riojas Individual Corporate DirectorCeo Apr 1, 1978
W-2 Managing EmployeeCeo Apr 1, 1978
Silverio Vivanco-Sanchez Individual Corporate DirectorBoard Member May 8, 2008

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Sea Mar CHC-Vashon IslandVashon, WA, CCN 941082 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jul 19, 1978
Sea Mar Community Health CentersSpanaway, WA, CCN 941095 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jul 19, 1978

Practitioners & affiliated clinicians

Practitioners 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1167955200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1787788800000",
    "number": "1912055286",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 34703",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981241703"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10217 125TH STREET CT E FL 2",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983742761",
            "telephone_number": "253-864-4550",
            "fax_number": "253-864-4558"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SEA MAR COMMUNITY HEALTH CENTERS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-05",
        "last_updated": "2026-08-27",
        "certification_date": "2026-08-27",
        "status": "A",
        "authorized_official_last_name": "BARTOLO",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "EXECUTIVE VICE PRESIDENT",
        "authorized_official_telephone_number": "206-763-5277"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "WA",
            "license": "6005372781",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7104466",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7123813",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1021994",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sea-Mar Community Health Center",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Sea Mar CHC Puyallup Medical",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Puyallup, WA

Sources for this page

Verify at the official NPI Registry.