Individual provider Active NPI

Daniel J Roubik, M.D.

  • Trauma Surgery Physician
  • Seattle, WA
National Provider Identifier
1922414663
Registry record updated Jun 13, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Trauma Surgery PhysicianTaxonomy code 2086S0127X
License
MD61264535 Issued in WA
Practice address
325 9TH Ave
Seattle, WA 98104-2420
Phone
(206) 520-5000
NPI assigned
Jul 2, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 13, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 26768 NE
Surgery Physician 208600000X MD61264535 WA
Trauma Surgery Physician 2086S0127X MD61264535 WA Primary

Addresses

Primary practice location

325 9TH Ave
Seattle, WA 98104-2420

Mailing address

PO Box 50095
Seattle, WA 98145-5095
Phone (206) 520-5700

Other practice location 1

3551 Roger Brooke Dr
Fort Sam Houston, TX 78234-4504
Phone (210) 539-9582

Other identifiers 1

IdentifierTypeStateIssuer
1922414663MedicaidWA

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
I20220614003378 WA Practitioner - General Surgery 5395124770 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The Association of University PhysiciansGroup PAC ID 0446162697, 3,484 clinicians

Practice addresses (Care Compare)

1321 Colby Ave
Everett, WA 98201-1665
Phone (425) 261-2000

325 9TH Ave
Seattle, WA 98104-2420
Phone (206) 731-3000

4112 Harbour Pointe Blvd SW
Suite 100
Mukilteo, WA 98275-5457
Phone (425) 347-6330

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
26768NEMDFemale Pelvic Medicine and Reconstructive Surgery (Obstetrics & Gynecology) Physician
MD61264535WAMDTrauma Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The Association of University Physicians Surgery CurrentSince Jul 1, 2022 Accepting new patients
Providence Health & Services - Washington CurrentSince Aug 14, 2023 Accepting new patients
Providence Health & Services- Washington CurrentSince Aug 14, 2023 Accepting new patients
Harborview Medical Center Past Accepting new patients

Locations

4112 Harbour Pointe Blvd SW
Ste 100
Mukilteo, WA 98275
Phone (425) 347-6330

1959 NE Pacific St
Seattle, WA 98195
Phone (206) 598-4333

325 9th Ave
Fl 8
Seattle, WA 98104

325 9th Ave
Seattle, WA 98104
Phone (206) 731-3000

Interoperability endpoints

  • Direct secure messaging: droubik1495296@direct.ehre.uwmedicine.org
  • Direct secure messaging: droubik2928192@wm.providencedirect.org

Organizations & group practices 4

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.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1404259200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655078400000",
    "number": "1922414663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 50095",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981455095",
            "telephone_number": "206-520-5700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "325 9TH AVE",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981042420",
            "telephone_number": "206-520-5000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3551 Roger Brooke Dr",
            "address_purpose": "LOCATION",
            "city": "Fort Sam Houston",
            "state": "TX",
            "postal_code": "782344504",
            "country_code": "US",
            "telephone_number": "210-539-9582",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROUBIK",
        "first_name": "DANIEL",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-07-02",
        "last_updated": "2022-06-13",
        "certification_date": "2022-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NE",
            "license": "26768",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "WA",
            "license": "MD61264535",
            "primary": false
        },
        {
            "code": "2086S0127X",
            "taxonomy_group": "",
            "desc": "Surgery, Trauma Surgery",
            "state": "WA",
            "license": "MD61264535",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1922414663",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Seattle, WA

Sources for this page

Verify at the official NPI Registry.