HOLLY PARK MEDICAL & DENTAL CLINIC
NPI 1902983109
Clinic/Center - Federally Qualified Health Center (FQHC) in Seattle, WA
About Holly Park Medical & Dental Clinic NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
HOLLY PARK MEDICAL & DENTAL CLINIC (NPI 1902983109) is a healthcare organization registered as a federally qualified health center (fqhc) in Seattle, Washington and active in the NPI registry since November 2006. The organization lists Hermes Shahbazian, Cfo, as its authorized official.
NPPES Registry Identity
Specialties & Licenses 3
Other Names 1
Other Identifiers 1
Group Practice 1
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)
Holly Park Medical & Dental Clinic is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
121Medicare enrollment records show 121 clinicians reassign Medicare billing to Holly Park Medical & Dental Clinic, which bills Medicare for the services they deliver. Of these, 20 practice at this address and 86 within 10 miles. Listed here are the 20 practicing nearest to this location.
Clinicians by Medicare Specialty 20
Nearest to this location (20)
See all 121Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Frequently 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 International Community Health Services's NPI number?
The NPI number for International Community Health Services is 1902983109. It was assigned to this organization in the NPPES registry on November 1, 2006. The provider is also known as Holly Park Medical & Dental Clinic.
Where is International Community Health Services located?
International Community Health Services is located at 3815 S Othello St 2nd Floor, Seattle, WA 98118. The listed phone number is (206) 788-3500.
What is International Community Health Services's specialty?
The primary specialty registered for this NPI is Clinic/Center, specializing in Federally Qualified Health Center (FQHC), with taxonomy code 261QF0400X.
Is International Community Health Services enrolled in Medicare?
Yes. International Community Health Services is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through International Community Health Services?
According to the CMS Revalidation Reassignment List (October 2026 release), 121 clinicians in 20 Medicare specialties reassign their Medicare billing to International Community Health Services. 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. The largest specialties are Family Practice (42), Nurse Practitioner (38) and Clinical Social Worker (12). Of these, 20 practice at this address and 86 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
What insurance does International Community Health Services accept?
Health plans from Ambetter Health and Premera Blue Cross Blue Shield of Alaska list International Community Health Services 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 International Community Health Services was last updated on April 7, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 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.
# Holly Park Medical & Dental Clinic · NPI 1902983109
Federally Qualified Health Center (FQHC) organization in Seattle, Washington. Organization record, active in the CMS NPPES registry since November 1, 2006.
## Identity
- **NPI:** 1902983109 (Entity type: Organization)
- **Enumerated:** November 1, 2006
- **Primary specialty:** Clinic/Center - Federally Qualified Health Center (FQHC) · taxonomy 261QF0400X
- **Legal business name:** International Community Health Services
- **Organization subpart:** Yes (part of International Community Health Services)
- **Authorized official:** Hermes Shahbazian, CFO
## Practice location
- **Address:** 3815 S OTHELLO ST, 2ND FLOOR, Seattle, WA 98118-3510
- **Phone:** (206) 788-3500 · **Fax:** (206) 788-3521
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 121 clinicians in 20 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Family Practice (42), Nurse Practitioner (38), Clinical Social Worker (12); 20 practice at this address and 86 within 10 miles; [full list](https://npiprofile.com/npi/1902983109/clinicians) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** April 7, 2021
- **Other identifiers:** Medicaid 7125289 (WA)
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Source: [NPI Profile](https://npiprofile.com/npi/1902983109) · Data from the CMS NPPES public registry.