NPIMap

Organization Active NPI

King County Public Hospital District No 2

  • Family Medicine Physician
  • Kirkland, WA
National Provider Identifier
1922540004
Registry record updated Nov 18, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
KING COUNTY PUBLIC HOSPITAL DISTRICT NO 2
Practice address
12710 Totem Lake Blvd NE
Kirkland, WA 98034-2907
Phone
(425) 821-4040
Fax
(425) 820-5060
NPI assigned
Nov 7, 2016
Organization subpart
Yes
Parent organization
KING COUNTY PUBLIC HOSPITAL DISTRICT NO 2As reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 18, 2016

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

Authorized official

Name
Robert Malte
Title
Ceo
Phone
(425) 899-2610

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X WA Primary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X WA
PodiatristGroup: 193200000X MULTI-SPECIALTY GROUP 213E00000X WA

Addresses

Primary practice location

12710 Totem Lake Blvd NE
Kirkland, WA 98034-2907

Mailing address

10131 Main St
Bothell, WA 98011-3425
Phone (425) 485-3955

Other names 1

  • EvergreenHealth Lakeshore Totem Lake Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
50D0630358Evergreenhealth Primary Care, Lakeshore Totem Lake12710 Totem Lake Blvd NE, Kirkland, WA 98034Certificate of waiverApr 4, 2028

National Provider Directory

National Provider Directory
Tax ID family
Ehmc Bothell Sr HLTH CT25 organizations share this tax ID, including this one
Part of
Ehmc Bothell Sr HLTH CT

Other organizations with this tax ID 24

Organizations that report the same tax identification number in the National Provider Directory.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1478476800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1479427200000",
    "number": "1922540004",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10131 MAIN ST",
            "city": "BOTHELL",
            "state": "WA",
            "postal_code": "980113425",
            "telephone_number": "425-485-3955",
            "fax_number": "425-485-1476"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12710 TOTEM LAKE BLVD NE",
            "city": "KIRKLAND",
            "state": "WA",
            "postal_code": "980342907",
            "telephone_number": "425-821-4040",
            "fax_number": "425-820-5060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KING COUNTY PUBLIC HOSPITAL DISTRICT NO 2",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KING COUNTY PUBLIC HOSPITAL DISTRICT NO 2",
        "enumeration_date": "2016-11-07",
        "last_updated": "2016-11-18",
        "status": "A",
        "authorized_official_last_name": "MALTE",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "425-899-2610"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "WA",
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "WA",
            "license": null,
            "primary": false
        },
        {
            "code": "213E00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Podiatrist",
            "state": "WA",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "EvergreenHealth Lakeshore Totem Lake",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kirkland, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.