NPIMap

Organization Active NPI

Emerald City Sports & Spine Medicine

Doing business as Lake Washington Sports & Spine

  • Medical Specialty Clinic/Center
  • Bellevue, WA
National Provider Identifier
1992074066
Registry record updated Feb 22, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Specialty Clinic/CenterTaxonomy code 261QM2500X
License
MD 39116 Issued in WA
Legal business name
EMERALD CITY SPORTS & SPINE MEDICINE
Doing business as
Lake Washington Sports & Spine
Practice address
1632 116TH Ave NE
Ste C
Bellevue, WA 98004-3035
Phone
(425) 818-0558
Fax
(888) 557-3062
NPI assigned
Dec 20, 2011
Last updated
Feb 22, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 22, 2012

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

Authorized official

Name
Garrett S Hyman, MD, MPHNPI 1871554675
Title
Physician Owner
Phone
(206) 852-8898

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
Medical Specialty Clinic/Center 261QM2500X MD 39116 WA Primary

Addresses

Primary practice location

1632 116TH Ave NE
Ste C
Bellevue, WA 98004-3035

Mailing address

6924 SE Allen St
Mercer Island, WA 98040-3357
Phone (206) 852-8898

Other names 1

  • Lake Washington Sports & Spine Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1324339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1329868800000",
    "number": "1992074066",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6924 SE ALLEN ST",
            "city": "MERCER ISLAND",
            "state": "WA",
            "postal_code": "980403357",
            "telephone_number": "206-852-8898"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1632 116TH AVE NE",
            "address_2": "STE C",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980043035",
            "telephone_number": "425-818-0558",
            "fax_number": "888-557-3062"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EMERALD CITY SPORTS & SPINE MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-20",
        "last_updated": "2012-02-22",
        "status": "A",
        "authorized_official_last_name": "HYMAN",
        "authorized_official_first_name": "GARRETT",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PHYSICIAN OWNER",
        "authorized_official_telephone_number": "206-852-8898",
        "authorized_official_credential": "MD, MPH"
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "WA",
            "license": "MD 39116",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lake Washington Sports & Spine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 22, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.