NPIMap

Organization Active NPI

International Community Health Services

  • Federally Qualified Health Center (FQHC)
  • Shoreline, WA
National Provider Identifier
1992124747
Registry record updated Mar 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
600436519 Issued in WA
Legal business name
INTERNATIONAL COMMUNITY HEALTH SERVICES
Practice address
16549 Aurora Ave N
Shoreline, WA 98133-5308
Phone
(206) 533-2600
Fax
(206) 533-2641
NPI assigned
Apr 9, 2014
Last updated
Mar 29, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
600436519As reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 29, 2021

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

Authorized official

Name
Hermes Shahbazian
Title
Cfo
Phone
(206) 788-3606

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Case Management Agency 251B00000X NU
Federally Qualified Health Center (FQHC) 261QF0400X 600436519 WA Primary
Family Medicine Physician 207Q00000X NU

Addresses

Primary practice location

16549 Aurora Ave N
Shoreline, WA 98133-5308

Mailing address

PO Box 3007
Seattle, WA 98114-3007
Phone (206) 788-3700

Other names 1

  • ICHS Shoreline Medical and Dental Clinic Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040301000204 WA Part B Supplier - Clinic/Group Practice 5799695672 Receives reassigned benefits from 130 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Bellevue, WA; Seattle, WA; Shoreline, WA; Auburn, WA
O20140916000862 WA Part A Provider - Federally Qualified Health Center (FQHC) 5799695672 Practice locations: Shoreline, WA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1992124747. Details of each certification follow.

Federally qualified health center certification: CCN 501974

Legal name
INTERNATIONAL COMMUNITY HEALTH SERVICES
Doing business as
ICHS SHORELINE MEDICAL AND DENTAL CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 2, 2014
Last certification
Sep 2, 2014
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Feb 24, 1976 in WA
Enrollment address
16549 Aurora Ave N
Shoreline, WA 98133-5308

Other NPIs with the same Medicare PAC ID 6

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 6

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

National Provider Directory

National Provider Directory
Tax ID family
International District33 organizations share this tax ID, including this one
Part of
International District

Other organizations with this tax ID 31

Organizations that report the same tax identification number in the National Provider Directory.

View all 31

Ownership & related parties

All disclosed owners & managing parties 10

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Mariam Abarientos Individual Corporate DirectorVolunteer Board Director Mar 22, 2017
Hermes Shahbzian Individual Corporate OfficerCfo May 6, 1994
W-2 Managing EmployeeCfo May 6, 1994
Catherine Johnson Individual Corporate DirectorVolunteer Board Director Jul 25, 2012
Gildas Cheung Individual Corporate DirectorVolunteer Board Director Jan 28, 2009
John Foz Individual Corporate DirectorVolunteer Board Director Sep 24, 2008
International Community Health Services Organization, Seattle, WA Corporation 5% Or Greater Direct Ownership Interest Sep 15, 2014 100%
Operational/Managerial Control Sep 15, 2014 100%
Marvin Eng Individual Corporate DirectorVolunteer Board Director Nov 27, 2019
Chengzhen Dai Individual Corporate DirectorVolunteer Board Director May 27, 2020
Amanda Kimura Individual Corporate DirectorVolunteer Board Director Aug 29, 2018
Kelli Nomura Individual Corporate OfficerCeo Nov 7, 2022
W-2 Managing EmployeeCeo Nov 7, 2022

Owners & managing parties with NPI records 6

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 3

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Ichs Bellevue Medical and Dental ClinicBellevue, WA, CCN 501971 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 May 1, 2014
May 1, 2014
Ichs International District Vision ClinicSeattle, WA, CCN 941034 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Sep 15, 2017
Sep 15, 2017
Ichs Sound Auburn Medical ClinicAuburn, WA, CCN 501074 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 May 1, 2025
May 1, 2025

Owned or controlled facilities with NPI records 3

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 3

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 24

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 24

NPI Registry JSON

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

{
    "created_epoch": "1397001600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1616976000000",
    "number": "1992124747",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3007",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981143007",
            "telephone_number": "206-788-3700",
            "fax_number": "206-788-3706"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16549 AURORA AVE N",
            "city": "SHORELINE",
            "state": "WA",
            "postal_code": "981335308",
            "telephone_number": "206-533-2600",
            "fax_number": "206-533-2641"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERNATIONAL COMMUNITY HEALTH SERVICES",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "600436519",
        "enumeration_date": "2014-04-09",
        "last_updated": "2021-03-29",
        "certification_date": "2021-03-29",
        "status": "A",
        "authorized_official_last_name": "SHAHBAZIAN",
        "authorized_official_first_name": "HERMES",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "206-788-3606"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "WA",
            "license": "600436519",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ICHS Shoreline Medical and Dental Clinic",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "ICHS Shoreline Medical and Dental Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Shoreline, WA

Sources for this page

Verify at the official NPI Registry.