SOUTHGATE MEDICAL CLINIC, P.S.
NPI 1285751990
Clinic/Center - Primary Care in Seattle, WA
About Southgate Medical Clinic, P.s. NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
SOUTHGATE MEDICAL CLINIC, P.S. (NPI 1285751990) is a healthcare organization registered as a primary care in Seattle, Washington and active in the NPI registry since March 2007. The organization holds a CLIA Waiver certificate valid through April 4, 2028 and lists Robert Alfiler Velasco, Owner, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Southgate Medical Clinic, P.s. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
2Medicare enrollment records show 2 clinicians reassign Medicare billing to Southgate Medical Clinic, P.S., which bills Medicare for the services they deliver. Of these, 1 practice at this address and 2 within 10 miles. They are listed nearest first.
Clinicians, nearest first (2)
Seattle, WA 98118
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
CLIA Laboratory Certificates CMS CLIA
Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.
Certificate of Waiver 50D0934866
Southgate Medical Clinic Ps · Seattle, WAFrequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Southgate Medical Clinic, P.S.'s NPI number?
The NPI number for Southgate Medical Clinic, P.S. is 1285751990. It was assigned to this organization in the NPPES registry on March 26, 2007.
Where is Southgate Medical Clinic, P.S. located?
Southgate Medical Clinic, P.S. is located at 6044 Martin Luther King Jr Way S Ste 104, Seattle, WA 98118. The listed phone number is (206) 723-9853.
What is Southgate Medical Clinic, P.S.'s specialty?
The primary specialty registered for this NPI is Clinic/Center, specializing in Primary Care, with taxonomy code 261QP2300X.
Is Southgate Medical Clinic, P.S. enrolled in Medicare?
Yes. Southgate Medical Clinic, P.S. is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Southgate Medical Clinic, P.S.?
According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians reassign their Medicare billing to Southgate Medical Clinic, P.S., in Family Practice and Nurse Practitioner. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 1 practice at this address and 2 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Southgate Medical Clinic, P.S. hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 50D0934866) is associated with this NPI, valid through April 4, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
What insurance does Southgate Medical Clinic, P.S. accept?
Health plans from Ambetter Health and Premera Blue Cross Blue Shield of Alaska list Southgate Medical Clinic, P.S. as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
When was this NPI record last updated?
The NPPES record for Southgate Medical Clinic, P.S. was last updated on August 22, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Southgate Medical Clinic, P.s. · NPI 1285751990
Primary Care organization in Seattle, Washington. Organization record, active in the CMS NPPES registry since March 26, 2007.
## Identity
- **NPI:** 1285751990 (Entity type: Organization)
- **Enumerated:** March 26, 2007
- **Primary specialty:** Clinic/Center - Primary Care · taxonomy 261QP2300X
- **Organization subpart:** No
- **Authorized official:** Robert Velasco, OWNER
## Practice location
- **Address:** 6044 MARTIN LUTHER KING JR WAY S STE 104, Seattle, WA 98118-3179
- **Phone:** (206) 723-9853
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 2 clinicians in 2 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Family Practice (1), Nurse Practitioner (1); 1 practice at this address and 2 within 10 miles · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** August 22, 2020
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1285751990) · Data from the CMS NPPES public registry.