COUNTRY DOCTOR COMMUNITY CLINIC (NPI# 1881885549) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1881885549 |
| Entity Type | Organization |
| Organization Name | COUNTRY DOCTOR COMMUNITY CLINIC |
| Other Organization Name | CAROLYN DOWNS FAMILY MEDICAL CENTER-MATERNAL SUPPORT SERVICES |
| Practice Address |
2101 E Yesler Way Suite 150 Seattle WA 98122-5959 |
| Mailing Address |
2101 E Yesler Way Suite 210 Seattle WA 98122-5959 |
| Practice Telephone | 2062991900 |
| Practice Fax Number | 2062991906 |
| Mailing Telephone | 2062991900 |
| Mailing Fax Number | 2062991920 |
| Enumeration Date | 2007-08-07 |
| Last Update Date | 2008-06-25 |
| Authorized Official Name | SHONNIE EVANS (QI MANAGER) |
| Authorized Official Telephone | 2062991984 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 171M00000X | Case Manager/Care Coordinator | Other Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WA | 7402852 | 05 |
| Other Name | Type Code |
|---|---|
| Carolyn Downs Family Medical Center-Maternal Support Services | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114540457 | Country Doctor Community Clinic | Family Medicine | 2410 E Cherry St, Seattle, WA 98122-4832 | 2020-05-21 |
| 1891343075 | Country Doctor Community Clinic | Clinic/Center | 1621 S Jackson St Ste 201, Seattle, WA 98144-2277 | 2019-08-30 |
| 1972623189 | Country Doctor Community Clinic | Case Management | 2101 E Yesler Way Ste 210, Seattle, WA 98122-5959 | 2007-03-30 |
| 1356999288 | Country Doctor Community Clinic | Clinic/Center | 301 21st Ave E, Seattle, WA 98112-5318 | 2019-09-04 |
| 1952883993 | Country Doctor Community Clinic | Clinic/Center | 510 19th Ave E, Seattle, WA 98112-4007 | 2018-09-06 |
| 1497189773 | Country Doctor Community Clinic | Clinic/Center | 550 16th Ave, Suite 100, Seattle, WA 98122-5699 | 2013-08-22 |
| 1316138696 | Country Doctor Community Clinic | Case Manager/Care Coordinator | 500 19th Ave E, Seattle, WA 98112-4007 | 2007-08-05 |
| 1952592230 | Country Doctor Community Clinic | Clinic/Center | 500 19th Ave E, Seattle, WA 98112-4007 | 2007-08-05 |
| 1902027253 | Country Doctor Community Clinic | Pharmacy | 2101 E Yesler Way, Suite 150, Seattle, WA 98122-5959 | 2007-05-02 |
| 1164642278 | Country Doctor Community Clinic | Family Medicine | 2101 E Yesler Way, Suite 150, Seattle, WA 98122-5959 | 2007-04-30 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Washington State Corporations | COUNTRY DOCTOR COMMUNITY CLINIC | 500 19th Ave E, Seattle, WA 98112-4007 |
| Street Address |
2101 E YESLER WAY SUITE 150 |
| City | SEATTLE |
| State | WA |
| Zip Code | 98122-5959 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447220439 | Sarah Ellen Lesko | Family Medicine | 2101 E Yesler Way, Suite 150, Seattle, WA 98122-5959 | 2006-01-24 |
| 1861927642 | Monica Lake | Counselor | 2101 E Yesler Way, Suite 150, Seattle, WA 98122-5959 | 2017-04-28 |
| 1770039745 | Irina A. Roganova | Dental Hygienist | 2101 E Yesler Way, Seattle, WA 98122-5959 | 2016-08-30 |
| 1437519246 | Paul Barry | Counselor | 2101 E Yesler Way, Suite 210, Seattle, WA 98122-5959 | 2016-03-07 |
| 1801267273 | Susanne Wieand | Registered Nurse | 2101 E Yesler Way, Seattle, WA 98122-5959 | 2015-10-12 |
| 1912386129 | Erin Leinn | Counselor | 2101 E Yesler Way, Seattle, WA 98122 | 2015-05-20 |
| 1023413499 | Stacey Haynes | Psychologist | 2101 E Yesler Way, Seattle, WA 98122-5959 | 2014-10-28 |
| 1902211576 | Amanda Beth Patterson | Dentist | 2101 E Yesler Way, Seattle, WA 98122-5959 | 2014-06-23 |
| 1962812032 | Teresa M. Resch | Dental Hygienist | 2101 E Yesler Way, Seattle, WA 98122-5959 | 2014-04-29 |
| 1528403755 | Rebecca Finkel | Dietitian, Registered | 2101 E Yesler Way, Seattle, WA 98122-5959 | 2013-05-01 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053938506 | Quality Counseling and Consultation Service LLC | Counselor | 1525 Harvard Ave #509, Seattle, WA 98122 | 2020-07-01 |
| 1912535626 | Cesar Andrade | Student in an Organized Health Care Education/Training Program | 550 16th Avenue #400, Seattle, WA 98122 | 2020-03-29 |
| 1366089666 | Peter Nguyen | Pharmacy Technician | 914 East Jefferson Street, Campion Hall, Seattle, WA 98122 | 2019-12-05 |
| 1356903140 | Jason Dandino | Specialist/Technologist | 550 14th Avenue, Seattle, WA 98122 | 2019-07-02 |
| 1962066415 | Seattle Colleges | Local Education Agency (LEA) | Mainstay At Seattle Central College, 1701 Broadway Ms Be3210, Seattle, WA 98122 | 2019-04-30 |
| 1538621412 | Mitchell R Ornelas | Student in an Organized Health Care Education/Training Program | Swedish Family Medicine Residency Cherry Hill; 550 16th, Avenue #400, Seattle, WA 98122 | 2019-04-01 |
| 1003374265 | Michael Russell | Surgery | 747 Broadway Heath Building 10th Floor, Seattle, WA 98122 | 2019-03-06 |
| 1639646821 | Maritza E Cajiao | Doula | 747 Broadway, Seattle, Seattle, WA 98122 | 2018-10-25 |
| 1336616762 | Suzanna M Lovin | Social Worker | 401 Broadway, 1st Floor, Seattle, WA 98122 | 2018-10-24 |
| 1184137770 | Walter Franklin Krengel Jr. | Orthopaedic Surgery | 2000 1st Ave Suite 2201, Seattle, WA 98122 | 2017-11-06 |
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| Taxonomy Code | 171M00000X |
| Grouping | Other Service Providers |
| Classification | Case Manager/Care Coordinator |
| A person who provides case management services and assists an individual in gaining access to needed medical, social, educational, and/or other services. The person has the ability to provide an assessment and review of completed plan of care on a periodic basis. This person is also able to take collaborative action to coordinate the services with other providers and monitor the enrollee’s progress toward the cost-effective achievement of objectives specified in the plan of care. Credentials may vary from an experience in the fields of psychology, social work, rehabilitation, nursing or a closely related human service field, to a related Assoc of Arts Degree or to nursing credentials. Some states may require certification in case management. |
| Notes: Source: CMS State Medicaid Manual Section 4442.3 [7/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013523737 | Christine Siebels-lindquist | Case Manager/Care Coordinator | 4039 9th Ave Ne, Seattle, WA 98105-6476 | 2020-09-17 |
| 1114549029 | Kathryn Larimore | Case Manager/Care Coordinator | 2100 24th Ave S Ste 250, Seattle, WA 98144-4644 | 2020-05-13 |
| 1205469152 | Davis Haywood | Case Manager/Care Coordinator | 325 9th Ave # 359607, Seattle, WA 98104-2420 | 2020-02-19 |
| 1932753241 | Marlene Rebecca Carricaburu | Case Manager/Care Coordinator | 325 9th Ave # 359859, Seattle, WA 98104-2499 | 2019-07-25 |
| 1518528173 | Michael Humphrey | Case Manager/Care Coordinator | 1119 E Fir St, Seattle, WA 98122-5415 | 2019-06-25 |
| 1801359377 | Maluofiti Valentino Le'iato | Case Manager/Care Coordinator | 12037 1st Ave S Apt B205, Seattle, WA 98168-5035 | 2019-04-10 |
| 1780156992 | Michelle Nayoung Kim | Case Manager/Care Coordinator | 1618 S Lane St, Seattle, WA 98144-2829 | 2018-12-28 |
| 1487125407 | Erin David Tate | Case Manager/Care Coordinator | 5444 Delridge Way Sw, Seattle, WA 98106-1534 | 2018-12-17 |
| 1710452362 | Carrie Jambresic | Case Manager/Care Coordinator | 5126 47th Ave Ne, Seattle, WA 98105-2925 | 2018-10-10 |
| 1063996601 | Laura Nagel | Case Manager/Care Coordinator | 2131 N 113th St Apt 3, Seattle, WA 98133-7644 | 2018-09-19 |
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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.