Active NPI
Russell S Goldberg, MD
- Internal Medicine Physician
- Kirkland, WA
National Provider Identifier
1962425462
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- MD00020625
- Practice address
- 13014 120TH Ave NE
Kirkland, WA 98034-3015 - Phone
- (425) 821-8004
- NPI assigned
- Jul 25, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | MD00020625 | WA | Primary |
Addresses
Primary practice location
13014 120TH Ave NE
Kirkland, WA 98034-3015
Mailing address
1100 9TH Ave
Ms M4-PA
Seattle, WA 98101-2756
Phone (206) 583-6025
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| GO7787 | Other | WA | BLUE SHIELD |
| 1109404 | Medicaid | WA | |
| US0900001 | Other | WA | AETNA/USHC PCP |
| 0039581 | Other | WA | LABOR & INDUSTRY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD00020625 | WA | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Virginia Mason Medical Center | Current | Accepting new patients | |
| Virginia Mason Medical Center | Current | Accepting new patients | |
| Virginia Mason Medical Center | Current | Accepting new patients | |
| Virginia Mason Medical Center | Current | Accepting new patients | |
| Virginia Mason Medical Center | Current | Accepting new patients | |
| Virginia Mason Medical Center- | Current | Accepting new patients | |
| Virginia Mason Medical Center | Current | Accepting new patients | |
| Virginia Mason Medical Center | Current | Accepting new patients | |
| Virginia Mason Medical Center | Current | Accepting new patients | |
| Virginia Mason Medical Center | Current | Accepting new patients | |
| Virginia Mason Medical Center | Current | Accepting new patients | |
| Virginia Mason Medical Center | Current | Accepting new patients | |
| Virginia Mason Medical Center | Current | Accepting new patients | |
| Virginia Mason Medical Center | Current | Accepting new patients | |
| Virginia Mason Medical Center | Current | Accepting new patients | |
| Virginia Mason Medical Center | Current | Accepting new patients | |
| Virginia Mason Medical Center | Current | Accepting new patients | |
| Virginia Mason Medical Center | Current | Accepting new patients | |
| Virginia Mason Medical Center | Current | Accepting new patients | |
| Virginia Mason Medical Center | Current | Accepting new patients |
Locations
33501 1st Way S
Federal Way, WA 98003
Phone (253) 838-2400
1100 9th Ave
#M4
Seattle, WA 98101
Phone (206) 515-5811
925 Seneca St
Seattle, WA 98101
Phone (206) 341-0860
Interoperability endpoints
- russell.goldberg@direct.vmmc.org
Organizations & group practices 20
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.
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153785600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1302739200000",
"number": "1962425462",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1100 9TH AVE",
"address_2": "MS M4-PA",
"city": "SEATTLE",
"state": "WA",
"postal_code": "981012756",
"telephone_number": "206-583-6025",
"fax_number": "206-515-5886"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13014 120TH AVE NE",
"city": "KIRKLAND",
"state": "WA",
"postal_code": "980343015",
"telephone_number": "425-821-8004"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOLDBERG",
"first_name": "RUSSELL",
"middle_name": "S",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-25",
"last_updated": "2011-04-14",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "WA",
"license": "MD00020625",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD",
"identifier": "GO7787",
"state": "WA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1109404",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA/USHC PCP",
"identifier": "US0900001",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LABOR & INDUSTRY",
"identifier": "0039581",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}
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 Apr 14, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.