NPIMap

Organization Active NPI

Sea Mar Community Health Centers

  • Federally Qualified Health Center (FQHC)
  • Spanaway, WA
National Provider Identifier
1922624642
Registry record updated Feb 26, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
SEA MAR COMMUNITY HEALTH CENTERS
Practice address
225 176TH St S
Spanaway, WA 98387-9201
Phone
(253) 240-2130
Fax
(253) 240-2133
NPI assigned
Jun 18, 2020
Last updated
Feb 26, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 26, 2025

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 13

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X
Nutritionist 133N00000X
Registered Dietitian 133V00000X
Pediatric Nutrition Registered Dietitian 133VN1004X
Renal Nutrition Registered Dietitian 133VN1005X
Metabolic Nutrition Registered Dietitian 133VN1006X
Registered Nurse 163W00000X
Physical Medicine & Rehabilitation Physician 208100000X
Spinal Cord Injury Medicine Physician 2081P0004X
Sports Medicine (Physical Medicine & Rehabilitation) Physician 2081S0010X
Occupational Therapist 225X00000X
Health Educator 174H00000X

Addresses

Primary practice location

225 176TH St S
Spanaway, WA 98387-9201

Mailing address

PO Box 34703
Seattle, WA 98124-1703

Other identifiers 1

IdentifierTypeStateIssuer
2164523MedicaidWA

Other names 2

  • Sea-Mar Community Health Center Former legal business name
  • Sea Mar CHC Spanaway 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…
O20210409000542 WA Part A Provider - Federally Qualified Health Center (FQHC) 7315831161 Practice locations: Spanaway, WA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1922624642. Details of each certification follow.

Federally qualified health center certification: CCN 941095

Legal name
SEA MAR COMMUNITY HEALTH CENTERS
Doing business as
SEA MAR COMMUNITY HEALTH CENTERS
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 6, 2021
Last certification
Apr 6, 2021
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Apr 14, 1977 in WA
Enrollment address
225 176TH St S
Spanaway, WA 98387-9201

Other NPIs on the same Medicare enrollment 41

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

View all 41

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
50D2213225Sea Mar Community Health Centers Spanaway Medical225 176TH St S, Spanaway, WA 98387Certificate of waiverApr 4, 2028

National Provider Directory

National Provider Directory
Tax ID family
Sea Mar Marysville Medi279 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

16410 Smokey Point Blvd
#2
Arlington, WA 98223
Phone (360) 653-1742

1811 156th Ave NE
Ste 2
Bellevue, WA 98007
Phone (425) 460-7125

3010 State Route 109
Copalis Beach, WA 98535
Phone (360) 289-2427

24215 Pacific Hwy S
Des Moines, WA 98198
Phone (206) 436-6380

515 W Main St
Elma, WA 98541
Phone (360) 482-5298

6884 Hannegan Rd
Everson, WA 98247
Phone (360) 354-0766

512 Grover St
Lynden, WA 98264

9710 State Ave
Marysville, WA 98270
Phone (360) 653-1742

17707 W Main St
#1
Monroe, WA 98272
Phone (360) 282-3885

110 N Laventure Rd
Ste D
Mount Vernon, WA 98273
Phone (360) 424-5344

10217 125th Street Ct E
Puyallup, WA 98374
Phone (253) 864-4550

8915 14th Ave S
Seattle, WA 98108
Phone (206) 762-0876

8915 14th Ave S
#303
Seattle, WA 98108
Phone (206) 764-4717

1412 NE 88th St
Vancouver, WA 98665
Phone (360) 574-4074

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Juan Enrique Garza Individual Corporate Director Feb 4, 2025
Daniela Diaz de la Vega Gonzales Individual Corporate DirectorPatient Representative, Homeless Jun 6, 2023 9%
Mary Bartolo Individual Corporate OfficerExecutive Vice President Jun 1, 1978
W-2 Managing EmployeeExecutive Vice President Jun 1, 1978
Agustin Delgado Individual Corporate DirectorVice Chair, Patient Representative Mar 13, 2013 9%
Kristina Kathleen Hoeschen Individual Corporate OfficerChief Compliance Officer- Managing May 1, 2017
W-2 Managing EmployeeChief Compliance Officer- Managing May 1, 2017
Ricardo Gasca Individual Corporate DirectorVice Chair, Community Rep Oct 16, 2016 9%
Gregory J Ma Individual Corporate DirectorChair, Patient Representative Sep 1, 1982 9%
Bertha Michelle Danley Individual Corporate DirectorQuality Improvement Chair Nov 1, 2001 9%
Felipe Trinidad-Martinez Individual Corporate DirectorMigrant Representative May 8, 2008 9%
Erasmo Gamboa Individual Corporate DirectorTreasurer, Community Rep Apr 10, 2010 9%
Rogelio Riojas Individual Corporate OfficerPresident, Ceo Apr 1, 1978
Sea Mar Community Health Centers Organization, Seattle, WA Non-profit 5% Or Greater Direct Ownership Interest Jul 19, 1978 100%
Silverio Vivanco-Sanchez Individual Corporate DirectorMigrant Representative May 8, 2008 9%

All facility ownership & control disclosures 1

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

Facilities with the same owner 1

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 561

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.

View all 561

NPI Registry JSON

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

{
    "created_epoch": "1592438400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1740528000000",
    "number": "1922624642",
    "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": "225 176TH ST S",
            "city": "SPANAWAY",
            "state": "WA",
            "postal_code": "983879201",
            "telephone_number": "253-240-2130",
            "fax_number": "253-240-2133"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SEA MAR COMMUNITY HEALTH CENTERS",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-18",
        "last_updated": "2025-02-26",
        "certification_date": "2025-02-26",
        "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": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "133N00000X",
            "taxonomy_group": "",
            "desc": "Nutritionist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "133VN1004X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered, Nutrition, Pediatric",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "133VN1005X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered, Nutrition, Renal",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "133VN1006X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered, Nutrition, Metabolic",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2081P0004X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Spinal Cord Injury Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2081S0010X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Sports Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "174H00000X",
            "taxonomy_group": "",
            "desc": "Health Educator",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2164523",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sea-Mar Community Health Center",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Sea-Mar Community Health Center",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Sea Mar CHC Spanaway Medical",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Spanaway, WA

Sources for this page

Verify at the official NPI Registry.