OVERLAKE COLON & RECTAL CLINIC, PLLC (NPI# 1063688273) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063688273 |
| Entity Type | Organization |
| Organization Name | OVERLAKE COLON & RECTAL CLINIC, PLLC |
| Practice Address |
1135 116th Ave Ne Suite 190 Bellevue WA 98004-4623 |
| Mailing Address |
Po Box 597 Bellevue WA 98009-0597 |
| Practice Telephone | 4256467400 |
| Practice Fax Number | 4256467449 |
| Mailing Telephone | 2066697639 |
| Enumeration Date | 2008-05-07 |
| Last Update Date | 2019-09-04 |
| Authorized Official Name | MITRA EHSAN (OWNER) |
| Authorized Official Telephone | 2066697639 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 208600000X | Surgery | MD00039612 | WA | Allopathic & Osteopathic Physicians |
| Y | 208C00000X | Colon & Rectal Surgery | MD00039612 | WA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WA | REGENCE | 1135EH | 01 |
| WA | L&I | 0159746 | 01 |
| WA | AETNA | 5810380 | 01 |
| WA | 1115864 | 05 | |
| WA | UNITED HEALTH CARE | 2185705 | 01 |
| Street Address |
1135 116TH AVE NE SUITE 190 |
| City | BELLEVUE |
| State | WA |
| Zip Code | 98004-4623 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992702443 | The Eastside Endoscopy Center LLC | Clinic/Center | 1135 116th Ave Ne, Suite 570, Bellevue, WA 98004-4623 | 2005-06-30 |
| 1366092728 | Sharpevision Pllc | Optometrist | 1135 116th Ave Ne, Bellevue, WA 98004-4623 | 2019-09-18 |
| 1447775960 | Ngan Kim Hoang | Pharmacist | 1135 116th Ave Ne, #105, Bellevue, WA 98004 | 2017-08-04 |
| 1871831420 | Jacqueline Suzanne Berkeihiser | Counselor | 1135 116th Ave Ne, Suite 400, Bellevue, WA 98004-4623 | 2013-01-16 |
| 1306193255 | Raisa R Volodarsky | Pharmacist | 1135 116th Ave Ne, Suite#105, Bellevue, WA 98004-4623 | 2012-08-09 |
| 1952673238 | Northwest Center for Urology | Urology | 1135 116th Ave Ne, Ll160, Bellevue, WA 98004-4629 | 2012-02-02 |
| 1548545973 | Daniel Hee-chul Hahm | Pharmacist | 1135 116th Ave Ne, Suite#105, Bellevue, WA 98004-4623 | 2011-10-17 |
| 1811272792 | Kendra Lian Marks | Audiologist | 1135 116th Ave Ne, Suite 500, Bellevue, WA 98004-4623 | 2011-10-11 |
| 1134439540 | Aeisha Bhatti Adnan | Physician Assistant | 1135 116th Ave Ne, Suite 620, Bellevue, WA 98004-4623 | 2010-10-19 |
| 1730496092 | Washington Urology Associates, Pllc | Clinic/Center | 1135 116th Ave Ne, Suite 620, Bellevue, WA 98004-4623 | 2010-09-08 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306458328 | Geneva Paula Hoskins-dorsey | Nurse Practitioner | 11120 Ne 33rd Place, Suite 202, Bellevue, WA 98004 | 2020-08-20 |
| 1720553613 | Christine Eyler | Pediatrics | Bellevue Pediatrics, C & C Medical Associates, 1940 116th Ave Ne, Ste 200, Bellevue, WA 98004 | 2018-10-08 |
| 1437634730 | Hazelden Betty Ford Foundation | Clinic/Center | 1231 116th Ave. Ne Suite 410, Bellevue, WA 98004 | 2018-10-02 |
| 1356827828 | Seattle Spine Group, Pllc | Orthopaedic Surgery | 1220 116th Ave Ne Ste 102, Bellevue, WA 98004 | 2018-07-17 |
| 1669989216 | Atsuko Nakajima | Acupuncturist | 2223 112th Ave. Ne, Ste 201, Bellevue, WA 98004 | 2018-01-04 |
| 1740794718 | Radka Chapin Counseling, LLC | Clinic/Center | 1611 116th Ave Ne Ste 119, Bellevue, WA 98004 | 2017-11-28 |
| 1962912105 | Cuyler Ann Simmons | Counselor | 3805 108th Ave Ne Ste 204, Bellevue, WA 98004 | 2017-10-02 |
| 1639690357 | Nicolas Lopez-montalvo | Behavioral Analyst | 3003 Northup Way Suite 200, Bellevue, WA 98004 | 2017-07-03 |
| 1124579537 | Matthew Thomas Haley | Pharmacist | 107 Bellevue Way, Se, Bellevue, WA 98004 | 2016-10-20 |
| 1649727348 | Kelsey Tanaka | Nurse Practitioner | 400- 108th Ave Ne, Suite 100, Bellevue, WA 98004 | 2016-09-10 |
| Find all providers in zip 98004 | ||||
| Taxonomy Code | 208C00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Colon & Rectal Surgery |
| A colon and rectal surgeon is trained to diagnose and treat various diseases of the intestinal tract, colon, rectum, anal canal and perianal area by medical and surgical means. This specialist also deals with other organs and tissues (such as the liver, urinary and female reproductive system) involved with primary intestinal disease. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Colon and Rectal Surgery, 2007. http://www.abcrs.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Colon and Rectal Surgery. Colon and rectal surgeons have the expertise to diagnose and often manage anorectal conditions such as hemorrhoids, fissures (painful tears in the anal lining), abscesses and fistulae (infections located around the anus and rectum) in the office setting. They also treat problems of the intestine and colon, and perform endoscopic procedures to evaluate and treat problems such as cancer, polyps (precancerous growths) and inflammatory conditions. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053332098 | Mitra Ehsan | Colon & Rectal Surgery | 1231 116th Ave Ne Ste 535, Bellevue, WA 98004-3804 | 2006-07-23 |
| 1699918169 | Ian R White | Colon & Rectal Surgery | 1135-116th Avenue Ne, Suite 550, Bellevue, WA 98004 | 2009-04-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619049616 | James C.s. Colquhoun | Colon & Rectal Surgery | 5515 S Custer Rd, Spokane, WA 99223-1628 | 2006-11-14 |
| 1740226570 | Joshua Eric Levin | Colon & Rectal Surgery | 3124 S 19th St Ste 220, Tacoma, WA 98405-2433 | 2006-06-21 |
| 1578528519 | Richard Parker Billingham | Colon & Rectal Surgery | 1101 Madison St Ste 500, Seattle, WA 98104-3557 | 2006-04-20 |
| 1972584936 | Phillip A Dean | Colon & Rectal Surgery | 4011 Talbot Rd S Ste 420, Renton, WA 98055-5791 | 2005-11-08 |
| 1235524703 | Crystal Pickeral Koerner | Colon & Rectal Surgery | 1101 Madison St Ste 500, Seattle, WA 98104-3557 | 2015-04-01 |
| 1598054355 | Ulrik Georg Wallin | Colon & Rectal Surgery | 1145 Broadway, Seattle, WA 98122-4201 | 2011-04-01 |
| 1073839965 | Laila Rashidi | Colon & Rectal Surgery | 3124 S 19th St Ste C220, Tacoma, WA 98405-2481 | 2010-04-16 |
| 1245566348 | Kitsap Colorectal Surgery Inc Ps | Colon & Rectal Surgery | 2528 Wheaton Way, Suite 103, Bremerton, WA 98310-3305 | 2009-10-23 |
| 1588828859 | Andrew Todd Schlussel | Colon & Rectal Surgery | 9040 Jackson Ave, Madigan Army Medical Center, Department of Surgery, Tacoma, WA 98433 | 2008-07-15 |
| 1598927642 | Jennifer Kim Lee | Colon & Rectal Surgery | 1101 Madison St, Suite 510, Seattle, WA 98104-1306 | 2008-06-30 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.