JOSEPH WALTER UPTON III MD
NPI 1255512885
General Practice in Kirkland, WA

NPI Status: Active since November 26, 2007

Contact Information

140 CENTRAL WAY
KIRKLAND, WA
ZIP 98033
Phone: (425) 300-6656
Fax: (425) 629-3065

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  • Individual
  • Male
  • General Practice
  • Accepts Insurance
  • PECOS Enrolled
  • Opted-Out Medicare

About JOSEPH UPTON

This page provides the complete NPI Profile along with additional information for Joseph Upton, a primary care provider established in Kirkland, Washington with a medical specialization in General Practice. The healthcare provider is registered in the NPI registry with number 1255512885 assigned on November 2007. The practitioner's primary taxonomy code is 208D00000X with license number MD00032129 (WA). The provider is registered as an individual and his NPI record was last updated 2 years ago.

NPI
1255512885
Provider Name
JOSEPH WALTER UPTON III MD
Gender
Male
Entity Type
Individual
Location Address
140 CENTRAL WAY KIRKLAND, WA 98033
Location Phone
(425) 300-6656
Location Fax
(425) 629-3065
Mailing Address
10047 MAIN ST STE 103 BELLEVUE, WA 98004
Mailing Phone
(425) 861-6258
Is Sole Proprietor?
No
Enumeration Date
11-26-2007
Last Update Date
08-28-2024
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A primary care provider (PCP) like Joseph Upton sees people with common medical problems. The primary care provider might be a doctor, physician assistant, nurse practitioner or clinic that are usually involved in your long-term care. A PCP might provide preventive care, treat common medical conditions, identify urgent medical problems and refer you to specialists when necessary. Primary care is usually provided in an outpatient facility but if you are admitted to a hospital your PCP may assist in your care. The most common medical conditions seen by primary care providers are: hypertension, upper respiratory tract infections, depression or anxiety, back pain, arthritis, dermatitis, diabetes, urinary tract infections, etc .

The provider doesn't accept Medicare and has signed an affidavit to be excluded from the Medicare program. If you are a Medicare beneficiary this means a provider can charge whatever they want for services rendered but must follow certain rules to do so. Joseph Upton opted out of Medicare effective on 05-17-2017 until 05-17-2027. Opt out periods last for two years and cannot be terminated unless the provider is opting out for the very first time and the affidavit is terminated no later than 90 days after the opt out effective date. Opt-out affidavits might renew automatically renew every two years. The provider opted out of Medicare but is permitted to order and refer services to other healthcare providers.

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

General Practice

Taxonomy Code
208D00000X
Type
Allopathic & Osteopathic Physicians
License No.
MD00032129
License State
WA
Taxonomy Description
A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee

Insurance Plans Accepted

According to publicly available information the provider might be accepting the following health plans from these health insurance companies:

  • Molina Gold Core 1640 - HMO
  • Molina Gold Core 1640 Plus with Adult Dental and Vision - HMO
  • Molina Gold Core 1640 Plus with Adult Vision - HMO
  • Molina Gold Saver 750 - HMO
  • Molina Gold Saver 750 Plus with Adult Dental and Vision - HMO
  • Molina Gold Saver 750 Plus with Adult Vision - HMO
  • Molina Gold Standard - HMO
  • Molina Silver Core - HMO
  • Molina Silver Core Plus with Adult Dental and Vision - HMO
  • Molina Silver Core Plus with Adult Vision - HMO
  • Molina Silver Saver with Four Free PCP Visits - HMO
  • Molina Silver Standard - HMO
  • Core Bronze HSA 10600 - EPO
  • Core Bronze HSA 7500 - EPO
  • Core Bronze HSA 8300 - EPO
  • Core Gold 1500 - EPO
  • Core Gold 3000 - EPO
  • Core Silver 3500 - EPO
  • Core Silver 4500 - EPO
  • Core Silver 5000 - EPO
  • Core Silver 7500 - EPO
  • Core Standard Expanded Bronze HSA - EPO
  • Core Standard Gold - EPO
  • Core Standard Silver - EPO
  • PacificSource Oregon Standard Bronze HSA Plan Core - EPO
  • PacificSource Oregon Standard Gold Plan Core - EPO
  • PacificSource Oregon Standard Silver Plan Core - EPO
  • Premera Blue Cross Alaska One Gold - PPO
  • Premera Blue Cross Preferred Bronze 5800 HSA - PPO
  • Premera Blue Cross Preferred Bronze 6350 - PPO
  • Premera Blue Cross Preferred Gold 1500 - PPO
  • Premera Blue Cross Preferred Silver 4500 - PPO
  • Premera Blue Cross Standard Bronze II - PPO
  • Premera Blue Cross Standard Gold - PPO
  • Premera Blue Cross Standard Silver - PPO
  • Premera Blue Cross Family Dental - PPO
  • Premera Blue Cross Pediatric Dental - PPO

*Please verify directly with this provider to make sure your insurance plan is currently accepted.

Medicare Participation & PECOS Enrollment Status

Joseph Upton is enrolled in PECOS and is eligible to order or refer health care services for Medicare patients. The provider is eligible to order or refer: Part B Clinical Laboratory and Imaging, Durable Medical Equipment (DME), a Home Health Agency (HHA) and Power Mobility Devices.

What is PECOS?
PECOS is the online Medicare enrollment management system or Provider, Enrollment, Chain and Ownership System. The PECOS system is a database of providers who have registered with CMS as providers or suppliers. PECOS is the primary source of information about verified Medicare professionals. Providers that want to participate in this program need to enroll in PECOS with their NPI number to avoid denied claims.

  • Is the provider registered in PECOS? Yes

  • Opted-Out of Medicare? Yes

  • Opt-Out Effective Date: 05-17-2017

  • Opt-Out End Date: 05-17-2027

  • Eligible to Order and Refer? Yes

  • Eligible to Order or Refer Part B Clinical Laboratory and Imaging: Yes

  • Eligible to Order or Refer Durable Medical Equipment (DMEPOS): Yes

  • Eligible to Order or Refer a Home Health Agency (HHA): Yes

  • Eligible to Order or Refer Power Mobility Devices: Yes

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NPI NPI Number Validation

How NPI Validation Works

The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.

To verify the NPI 1255512885, we treat the final digit (5) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 55. The final step is to find the difference between that total and the next multiple of ten (60 - 55 = 5).

Digit-by-digit view

Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.

Pos 1
1
Doubled → 2
Pos 2
2
Unchanged
Pos 3
5
Doubled → 10 → 1 + 0
Pos 4
5
Unchanged
Pos 5
5
Doubled → 10 → 1 + 0
Pos 6
1
Unchanged
Pos 7
2
Doubled → 4
Pos 8
8
Unchanged
Pos 9
8
Doubled → 16 → 1 + 6
Check
5
Target digit
Regular digit Doubled digit Check digit

Step 1: Double every other digit from the right

Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.

1 → 2 5 → 10 → 1 5 → 10 → 1 2 → 4 8 → 16 → 7

Step 2: Add all digits plus the NPI constant

Add the transformed values, the unchanged digits, and the constant 24.

2 + 2 + 1 + 0 + 5 + 1 + 0 + 1 + 4 + 8 + 1 + 6 + 24 = 55

Step 3: Find the amount needed to reach the next multiple of 10

The next multiple of ten after 55 is 60. The difference is the calculated check digit.

60 - 55 = 5
This NPI is valid
The calculated check digit is 5, which matches the last digit of 1255512885.

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1255512885, enumerated as an "individual" on November 26, 2007.

The provider is located at 140 CENTRAL WAY KIRKLAND, WA 98033 and the phone number is (425) 300-6656.

General Practice with taxonomy code 208D00000X.

The provider might be accepting Accepts: Molina Healthcare, PacificSource Health Plans and. Please consult your insurance carrier or call the provider to verify.