RUSSOM DESTA MD
NPI 1245971209
Internal Medicine in Everett, WA

Q: What is Russom Desta's NPI number?

The NPI number for Russom Desta is 1245971209. It was assigned to this individual provider in the NPPES registry on April 5, 2022.

Q: What is Russom Desta's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Q: When was this NPI record last updated?

The NPPES record for Russom Desta was last updated on September 23, 2025. NPI Profile syncs with the weekly NPPES data releases published by CMS.

Active since April 05, 2022PECOS EnrolledAccepts Medicare Assignment

3901 HOYT AVE, EVERETT, WA 98201(425) 261-4076(425) 261-4078 Get Directions Write a Review

NPPES record last updated: September 23, 2025. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Jul 11, 2025, Apr 5, 2022 (2 updates tracked since 2022).

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About Russom Desta Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

RUSSOM DESTA MD (NPI 1245971209) is an individual internal medicine provider in Everett, Washington, licensed in Washington (MD61579314) and active in the NPI registry since April 2022. He is enrolled in Medicare PECOS, is affiliated with Providence Regional Medical Center Everett, and maintains a secondary practice location in Seattle.

NPPES Registry Identity

NPI1245971209

Entity TypeIndividualMale

Primary Taxonomy207R00000X

Provider Legal NameRUSSOM DESTACredential: MD

Location Address3901 HOYT AVEEverett, WA 98201-4918

Mailing AddressPo Box 5127Everett, WA 98206-5127 · (206) 860-5414 · Fax (206) 720-8462

Phone(425) 261-4076

Fax(425) 261-4078

Sole ProprietorNo

Medical School CMSMeharry Medical College School Of MedicineGraduated 2022

Enumeration DateApril 5, 2022

Last NPPES UpdateSeptember 23, 20252 updates tracked since enumeration

NPPES CertifiedSeptember 23, 2025

✔ NPI 1245971209 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207R00000X

License✔ Licensed in WA · MD61579314

Definition

A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.

Also ListedStudent in an Organized Health Care Education/Training ProgramTaxonomy 390200000X

3901 HOYT AVE, Everett, WA 98201

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Secondary Practice Location 1

Location 11959 NE Pacific StSeattle, WA 98195-0001 · Phone (206) 543-3605

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Premera Blue Cross Blue Shield of Alaska, Providence Health Plan.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Russom Desta Md is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID4486041308

PECOS Enrollment IDI20250828003359

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Providence Regional Medical Center Everett

Acute Care Hospitals · Everett, WA

3/5 CMS rating

OwnershipVoluntary non-profit - Church

CMS Certification Number500014

Location1321 Colby AvenueEverett, WA 98201 · Snohomish County

Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 98201 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$130.99 typical visit price

range $57.27 – $172.80

Typical copayment $32.74 (range $14.31 – $43.20)

Most-billed visit code 99204

Established Patient

$100.78 typical visit price

range $18.56 – $141.11

Typical copayment $25.19 (range $4.64 – $35.27)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

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Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

KELVIN KARL YU WONG M.D.

Family Medicine