NPIMap

Individual provider Active NPI

Jaekyung Song, M.D.

  • Internal Medicine Physician
  • Centralia, WA
National Provider Identifier
1972700656
Registry record updated Jun 6, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD60377532 Issued in WA
Practice address
914 S Scheuber Rd
Centralia, WA 98531
Phone
(360) 330-8976
NPI assigned
Jun 27, 2007
Last updated
Jun 6, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 6, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD60377532 WA Primary
Hospitalist Physician 208M00000X MD60377532 WA

Addresses

Primary practice location

914 S Scheuber Rd
Centralia, WA 98531

Mailing address

PO Box 3360
Portland, OR 97208-3360

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130722000493 WA Practitioner - Internal Medicine 7315188083 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Capital Medical Center Specialty Physicians LLCGroup PAC ID 2567651771, 103 clinicians

Practice addresses (Care Compare)

3900 Capital Mall Dr SW
Olympia, WA 98502-8654
Phone (360) 704-4743

413 Lilly Rd NE
Olympia, WA 98506-5133
Phone (360) 493-4083

914 S Scheuber Rd
Centralia, WA 98531-9027
Phone (360) 736-2803

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD60377532WAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Health & Services Washington CurrentSince May 7, 2018 Accepting new patients
Multicare Health System CurrentSince Jul 3, 2021 Accepting new patients
Multicare Health System CurrentSince Jul 3, 2021 Accepting new patients
Providence Health & Services Washington CurrentSince May 7, 2018 Accepting new patients
Multicare Health System Current Accepting new patients
Grays Harbor County Public Hospital District No 1 Current Accepting new patients
Capital Medical Center Specialty Physicians, LLC Hospitalist CurrentSince Jul 18, 2018 Accepting new patients
Multicare Health System Past Accepting new patients

Locations

914 S Scheuber Rd
Centralia, WA 98531
Phone (360) 330-8516

600 E Main St
Elma, WA 98541
Phone (360) 346-2222

4700 Point Fosdick Dr
Ste 104
Gig Harbor, WA 98335
Phone (253) 459-7590

222 State Ave N
Kent, WA 98030
Phone (253) 372-7680

3900 Capital Mall Dr SW
Olympia, WA 98502
Phone (360) 704-4743

413 Lilly Rd NE
Olympia, WA 98506
Phone (360) 491-9480

525 Lilly Rd NE
Olympia, WA 98506
Phone (360) 413-8550

407 14th Ave SE
Puyallup, WA 98372
Phone (253) 697-4000

Interoperability endpoints

  • Direct secure messaging: jsong003@direct.sp-mc.org
  • Direct secure messaging: jsong604279@direct.multicare.org

Organizations & group practices 9

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

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

NPI Registry JSON

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

{
    "created_epoch": "1182902400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1528243200000",
    "number": "1972700656",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3360",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972083360"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "914 S SCHEUBER RD",
            "city": "CENTRALIA",
            "state": "WA",
            "postal_code": "98531",
            "telephone_number": "360-330-8976"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SONG",
        "first_name": "JAEKYUNG",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-06-27",
        "last_updated": "2018-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WA",
            "license": "MD60377532",
            "primary": true
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "WA",
            "license": "MD60377532",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Centralia, WA

Sources for this page

Verify at the official NPI Registry.