NPIMap

Organization Active NPI

Neighborcare Health

Doing business as Neighborcare Health at Lake City

  • Federally Qualified Health Center (FQHC)
  • Seattle, WA
National Provider Identifier
1962754713
Registry record updated Sep 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
NEIGHBORCARE HEALTH
Doing business as
Neighborcare Health at Lake City
Practice address
12721 30TH Ave NE
Ste 101
Seattle, WA 98125-4498
Phone
(206) 417-0326
Fax
(206) 417-0783
NPI assigned
Oct 3, 2012
Last updated
Sep 10, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 10, 2025

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

Authorized official

Name
Charisse Marshall
Title
Director of Revenue Cycle
Phone
(206) 548-3102

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

12721 30TH Ave NE
Ste 101
Seattle, WA 98125-4498

Mailing address

1200 12TH Ave S Ste 901
Seattle, WA 98144-2712
Phone (206) 548-3114

Other identifiers 2

IdentifierTypeStateIssuer
501965OtherWACMS CERTIFICATION
2023330MedicaidWA

Other names 1

  • Neighborcare Health at Lake City Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040128000573 WA Part B Supplier - Clinic/Group Practice 0143134205 Receives reassigned benefits from 317 practitioners
15 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Seattle, WA; Vashon, WA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1962754713. Details of each certification follow.

  • CCN 501965 Federally qualified health center · Active · Name & address match · Details

Federally qualified health center certification: CCN 501965

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
NEIGHBORCARE HEALTH AT LAKE CITY
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 19, 2013
Last certification
Aug 19, 2013
Ownership / control type
Non-profit – corporation
Facility address
12721 30TH Avenue NE, Suite 101
Lake City, WA 98125

Other NPIs on the same Medicare enrollment 15

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

View all 15

National Provider Directory

National Provider Directory

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": "1349222400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757462400000",
    "number": "1962754713",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 12TH AVE S STE 901",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981442712",
            "telephone_number": "206-548-3114",
            "fax_number": "206-962-2342"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12721 30TH AVE NE",
            "address_2": "STE 101",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981254498",
            "telephone_number": "206-417-0326",
            "fax_number": "206-417-0783"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEIGHBORCARE HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-03",
        "last_updated": "2025-09-10",
        "certification_date": "2025-09-10",
        "status": "A",
        "authorized_official_last_name": "MARSHALL",
        "authorized_official_first_name": "CHARISSE",
        "authorized_official_title_or_position": "DIRECTOR OF REVENUE CYCLE",
        "authorized_official_telephone_number": "206-548-3102"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CMS CERTIFICATION",
            "identifier": "501965",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2023330",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Neighborcare Health at Lake City",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Seattle, WA

Sources for this page

Verify at the official NPI Registry.