Individual provider Active NPI

Sundara R Samavedi, MD

  • Internal Medicine Physician
  • Seattle, WA
National Provider Identifier
1912912767
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD00041631 Issued in WA
Practice address
10416 5TH Ave NE
Seattle, WA 98125-7402
Phone
(206) 517-6700
NPI assigned
Jul 30, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD00041631 WA Primary

Addresses

Primary practice location

10416 5TH Ave NE
Seattle, WA 98125-7402

Mailing address

10416 5TH Ave NE
Seattle, WA 98125-7402
Phone (206) 517-6700

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
I20160701000454 WA Practitioner - Family Practice 3971602939 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD00041631WAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Kaiser Foundation Health Plan of Washington CurrentSince Aug 16, 2016 Accepting new patients
Kaiser Foundation Health Plan of Washington Current Accepting new patients
Kaiser Foundation Health Plan of Washington CurrentSince Aug 16, 2016 Accepting new patients
Bourget Health Services Inc Past Accepting new patients
Public Hospital District 1 of King County Past Accepting new patients

Locations

11511 NE 10th St
Hunts Point, WA 98004
Phone (425) 502-3000

200 15th Ave E
Seattle, WA 98112
Phone (206) 326-4530

9505 S Steele St
Tacoma, WA 98444
Phone (253) 597-6800

Organizations & group practices 5

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": "1154217600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1912912767",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10416 5TH AVE NE",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981257402",
            "telephone_number": "206-517-6700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10416 5TH AVE NE",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981257402",
            "telephone_number": "206-517-6700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAMAVEDI",
        "first_name": "SUNDARA",
        "middle_name": "R",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-30",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WA",
            "license": "MD00041631",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Seattle, WA

Sources for this page

Verify at the official NPI Registry.