Individual provider Active NPI

Carlos E Villavicencio, MD

  • Hospitalist Physician
  • Seattle, WA
National Provider Identifier
1912056078
Registry record updated Sep 18, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospitalist PhysicianTaxonomy code 208M00000X
License
MD00044735 Issued in WA
Practice address
4800 Sand Point Way NE
Seattle, WA 98105-3901
Phone
(206) 987-2000
NPI assigned
Jan 9, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 18, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X MD00044735 WA
Hospitalist Physician 208M00000X MD00044735 WA Primary

Addresses

Primary practice location

4800 Sand Point Way NE
Seattle, WA 98105-3901

Mailing address

PO Box 50010
Seattle, WA 98105-1010
Phone (206) 987-8450

Other identifiers 1

IdentifierTypeStateIssuer
8423816MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050609000377 WA Practitioner - Pediatric Medicine 0941243026 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Pediatric Medicine
Education
Northwestern University Feinberg Medical School, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

4800 Sand Point Way NE
Seattle, WA 98105-3901
Phone (206) 526-2000

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD00044735WAMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The Association of Chrmc and University Physicians Pediatrics CurrentSince Aug 21, 2010 Accepting new patients
Association of CHMC and University Physicians Pediatrics CurrentSince Aug 21, 2010 Accepting new patients
Seattle Children'S Hospital Current Accepting new patients
Seattle Children'S Hospital CurrentSince Oct 3, 2021 Accepting new patients
Seattle Childrens Hospital CurrentSince Oct 3, 2021 Accepting new patients
Seattle Children'S Hospital Past Accepting new patients
Children'S Hospital & Regional Medical Center 2 Past Accepting new patients
Seattle Children'S Hospital Past Accepting new patients

Locations

1035 116th Ave NE
Bellevue, WA 98004
Phone (425) 451-4141

900 Pacific Ave
Ste 100
Everett, WA 98201
Phone (425) 304-6080

34503 9th Ave S
Ste 300
Federal Way, WA 98003
Phone (253) 838-5878

8232 W Grandridge Blvd
Kennewick, WA 99336
Phone (509) 582-1700

4800 Sand Point Way NE
Seattle, WA 98105
Phone (206) 526-2000

1780 NW Myhre Rd
Ste 2120
Silverdale, WA 98383
Phone (360) 782-3100

Interoperability endpoints

  • Direct secure messaging: cvillavicencio17862@direct.seattlechildrens.org

Organizations & group practices 8

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": "1168300800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1537228800000",
    "number": "1912056078",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 50010",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981051010",
            "telephone_number": "206-987-8450",
            "fax_number": "206-987-8484"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4800 SAND POINT WAY NE",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981053901",
            "telephone_number": "206-987-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VILLAVICENCIO",
        "first_name": "CARLOS",
        "middle_name": "E",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-09",
        "last_updated": "2018-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "WA",
            "license": "MD00044735",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "WA",
            "license": "MD00044735",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8423816",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Seattle, WA

Sources for this page

Verify at the official NPI Registry.