NPIMap

Organization Active NPI

Lake Washington Vascular PLLC

  • Vascular Surgery Physician
  • Bellevue, WA
National Provider Identifier
1942292875
Registry record updated Feb 25, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
Legal business name
LAKE WASHINGTON VASCULAR PLLC
Practice address
1135 116TH Ave NE Ste 305
Bellevue, WA 98004-4623
Phone
(425) 453-1772
Fax
(425) 453-0603
NPI assigned
Aug 17, 2005
Last updated
Feb 25, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 25, 2015

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

Authorized official

Name
Daniel Pepper, MDNPI 1619906328
Title
Managing Partner, PLLC
Phone
(425) 453-1772

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2086S0129X Primary

Addresses

Primary practice location

1135 116TH Ave NE Ste 305
Bellevue, WA 98004-4623

Mailing address

PO Box 94732
Seattle, WA 98124-7032
Phone (425) 453-1772

Other identifiers 2

IdentifierTypeStateIssuer
7105083MedicaidWA
CH9340OtherWARR MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040317001054 WA Part B Supplier - Clinic/Group Practice 6103716782 Receives reassigned benefits from 13 practitioners
Practice locations: Bellevue, WA; Issaquah, WA; Kirkland, WA

National Provider Directory

National Provider Directory

Locations

1135 116th Ave NE
Ste 305
Bellevue, WA 98004
Phone (425) 453-1772

1740 NW Maple St
Ste 200
Issaquah, WA 98027
Phone (425) 453-1772

Practitioners & affiliated clinicians

Practitioners 21

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 21

NPI Registry JSON

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

{
    "created_epoch": "1124236800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1424822400000",
    "number": "1942292875",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 94732",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981247032",
            "telephone_number": "425-453-1772",
            "fax_number": "425-453-0603"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1135 116TH AVE NE STE 305",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980044623",
            "telephone_number": "425-453-1772",
            "fax_number": "425-453-0603"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE WASHINGTON VASCULAR PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-17",
        "last_updated": "2015-02-25",
        "status": "A",
        "authorized_official_last_name": "PEPPER",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_title_or_position": "MANAGING PARTNER, PLLC",
        "authorized_official_telephone_number": "425-453-1772",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery, Vascular Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7105083",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "CH9340",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bellevue, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.