104TH AVENUE MEDICAL CLINIC INCORPORATED
NPI 1396921326
Clinic/Center in Kent, WA
NPI Status: Active since January 22, 2008
Contact Information
24604 104TH AVE SE
# 202
KENT, WA
ZIP 98030
Phone: (253) 859-8371
Fax: (253) 859-9593
- Organization
- Clinic/Center
- CLIA Number: 50D0976109
- CLIA Cert. Type: Other
- CLIA Exp. Date: 04-04-2028
About 104TH AVENUE MEDICAL CLINIC INCORPORATED
This page provides the complete NPI Profile along with additional information for 104th Avenue Medical Clinic Incorporated, a provider established in Kent, Washington operating as a Clinic/center. The healthcare provider is registered in the NPI registry with number 1396921326 assigned on January 2008. The practitioner's primary taxonomy code is 261Q00000X with license number 37861 (WA). The provider is registered as an organization and their NPI record was last updated 11 years ago. The authorized official of this NPI record is Ranu Choudhary M.d. (Vice-president)
- NPI
- 1396921326
- Provider Name
- 104TH AVENUE MEDICAL CLINIC INCORPORATED
- Entity Type
- Organization
- Location Address
- 24604 104TH AVE SE # 202 KENT, WA 98030
- Location Phone
- (253) 859-8371
- Location Fax
- (253) 859-9593
- Mailing Address
- 24604 104TH AVE SE # 202 KENT, WA 98030
- Mailing Phone
- (253) 859-8371
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 01-22-2008
- Last Update Date
- 10-01-2014
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Clinic/Center
- Taxonomy Code
- 261Q00000X
- Type
- Ambulatory Health Care Facilities
- License No.
- 37861
- License State
- WA
- Taxonomy Description
- A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Additional Identifiers
The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.
| Identifier | Type / Code | Identifier State | Identifier Issuer |
|---|---|---|---|
| H20548 | MEDICARE UPIN (02) | ||
| 1110378 | MEDICAID (05) | WA | |
| G8871735 | MEDICARE PIN (08) |
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 50D0976109
- Facility Type
- Other
- Certificate Effective Date
- January 28, 2010
- Certificate Expiration Date
- April 04, 2028
- Laboratory Director
- RANU CHOUDHARY MD
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to 104th Avenue Medical Clinic Incorporated to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.
Reviews for 104TH AVENUE MEDICAL CLINIC INCORPORATED
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NPI Validation Check Digit Calculation
The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.
| Start with the original NPI number, the last digit is the check digit and is not used in the calculation. | |||||||||
| 1 | 3 | 9 | 6 | 9 | 2 | 1 | 3 | 2 | 6 |
| Step 1: Double the value of the alternate digits, beginning with the rightmost digit. | |||||||||
| 2 | 3 | 18 | 6 | 18 | 2 | 2 | 3 | 4 | |
| Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24. | |||||||||
| 2 + 3 + 1 + 8 + 6 + 1 + 8 + 2 + 2 + 3 + 4 + 24 = 64 | |||||||||
| Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit. | |||||||||
| 70 - 64 = 6 | 6 | ||||||||
The NPI number 1396921326 is valid because the calculated check digit 6 using the Luhn validation algorithm matches the last digit of the original NPI number.
Other Providers at the Same Location
The following 7 providers are registered at the same or nearby location.
| NPI | Name / Type | Taxonomy | Address |
|---|---|---|---|
| 1265490700 | KINGMAN K HO MD Individual | Internal Medicine | 24604 104TH AVE SE SUITE 101 KENT, WA 98030 (253) 395-2001 |
| 1316904568 | DR. CLAUDIO GABRIEL ALPEROVICH MD, FACS Individual | Surgery | 24604 104TH AVE SE SUITE 201 KENT, WA 98030 (253) 220-8091 |
| 1447578562 | BARIGENS CLINIC PLLC Organization | Surgery | 24604 104TH AVE SE SUITE 201 KENT, WA 98030 (206) 353-8146 |
| 1629380258 | ALPEROVICH CLAUDIO G Organization | Surgery | 24604 104TH AVE SE SUITE 201 KENT, WA 98030 (253) 220-8091 |
| 1386664183 | RANU CHOUDHARY MD Individual | Internal Medicine | 24604 104TH AVE SE STE 202 KENT, WA 98030 (253) 859-8371 |
| 1255946315 | CITY SOUTH DERMATOLOGY PLLC Organization | Dermatology | 24604 104TH AVE SE KENT, WA 98030 (617) 412-1987 |
| 1104447598 | SAFA FEHRI MD Individual | Family Medicine | 24604 104TH AVE SE KENT, WA 98030 (877) 637-8387 |
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1396921326, enumerated in the NPI registry as an "organization" on January 22, 2008
The provider is located at 24604 104th Ave Se # 202 Kent, Wa 98030 and the phone number is (253) 859-8371
This medical organization specializes in Clinic/Center with taxonomy code 261Q00000X
The provider might be accepting Accepts: Medicare and Medicaid. Please consult your insurance carrier or call the provider to make sure your health plan is currently accepted.
The provider's CLIA number is 50D0976109 for a "other" facility with a CLIA Certificate of Waiver. This CLIA certificate is issued to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria..
This NPI record was last updated on January 22, 2008. To officially update your NPI information contact the National Plan and Provider Enumeration System (NPPES) at 1-800-465-3203 (NPI Toll-Free) or by email at [email protected].
NPI Profile data is regularly updated with the latest NPI registry information, if you would like to update or remove your NPI Profile in this website please contact us.