Esravila Ariya Wibisono, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

MD61603415 Issued in WA

Practice address

10004 204TH Ave E Ste 2200
Bonney Lake, WA 98391-6537

Phone

(253) 447-3300

NPI assigned

Jun 14, 2022

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in WA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Internal Medicine

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Multicare Health SystemGroup PAC ID 7719899897, 2,312 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Multicare Good Samaritan Home Health Home health agency, Tacoma, WA, CCN 507046
• Tacoma General Allenmore Hospital Hospital, Tacoma, WA, CCN 500129
• Multicare Good Samaritan Hospital Hospital, Puyallup, WA, CCN 500079

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ewibisono853883@direct.multicare.org
• Direct secure messaging: ewibisono2390723@direct.trinity-health.org

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.

• Multicare Health System

  • Neurological Surgery Physician
  • Tacoma, WA
  • NPI 1497766638
  Medicare reassignment Care Compare group NPD
• Multicare Health System

  • Clinical Medical Laboratory
  • Tacoma, WA
  • NPI 1154818326
  NPD
• Multicare Health System

  • Community/Retail Pharmacy
  • Spokane, WA
  • NPI 1396594875
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Multicare Health System

  • Home Health Agency
  • Tacoma, WA
  • NPI 1275647133
  Care Compare affiliation
• Multicare Health System

  • General Acute Care Hospital
  • Tacoma, WA
  • NPI 1366556227
  Care Compare affiliation
• Multicare Health System

  • General Acute Care Hospital
  • Puyallup, WA
  • NPI 1841231461
  Care Compare affiliation

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

{
    "created_epoch": "1655164800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753920000000",
    "number": "1972233708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10004 204TH AVE E STE 2200",
            "city": "BONNEY LAKE",
            "state": "WA",
            "postal_code": "983916537",
            "telephone_number": "253-447-3300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10004 204TH AVE E STE 2200",
            "city": "BONNEY LAKE",
            "state": "WA",
            "postal_code": "983916537",
            "telephone_number": "253-447-3300"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "56 Franklin St Ste 1",
            "address_purpose": "LOCATION",
            "city": "Waterbury",
            "state": "CT",
            "postal_code": "067061281",
            "country_code": "US",
            "telephone_number": "203-709-8685",
            "fax_number": "203-709-3518",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WIBISONO",
        "first_name": "ESRAVILA",
        "middle_name": "ARIYA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-06-14",
        "last_updated": "2025-07-31",
        "certification_date": "2025-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "CT",
            "license": "06-0646844",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WA",
            "license": "MD61603415",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Washington Dental Corporation, PC
• Jessica Anne Weatherseed, L.M.P.
• Micayla Weider, DC
• Nicholas C Welter, MD
• Stephen Alfred Wessenberg, PTA, BS, AS
• Sheila M Wiley, LMP
• Kelsey Williams, RN, BSN
• Amanda Wilson, LMP
• Kathryn Frances Wire, DPT
• Victoria F Wirtz, D.C.

• Internal Medicine Physician in Bonney Lake, WA
• Providers in Bonney Lake, WA by specialty
• Internal Medicine Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.