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LISA MARIE IVANJACK MD
NPI 1972541878
Internal Medicine in Bothell, WA

Active since June 03, 2006PECOS Enrolled
1909 214TH ST SE STE 300, BOTHELL, WA 98021(425) 412-7200 Get Directions Write a Review

NPPES record last updated: September 24, 2019. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Lisa Marie Ivanjack Md NPPES

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

LISA MARIE IVANJACK MD (NPI 1972541878) is an individual internal medicine provider in Bothell, Washington, licensed in Washington (MD00038351) and active in the NPI registry since June 2006. She is enrolled in Medicare PECOS and maintains a secondary practice location in Mukilteo.

NPPES Registry Identity

NPI1972541878
Entity TypeIndividualFemale
Primary Taxonomy207R00000X
Provider Legal NameLISA MARIE IVANJACKCredential: MD
Location Address1909 214TH ST SE STE 300Bothell, WA 98021
Mailing Address1909 214th St Se Ste 300Bothell, WA 98021-4418 · (425) 412-7200
Phone(425) 412-7200
Sole ProprietorNo
Enumeration DateJune 3, 2006
Last NPPES UpdateSeptember 24, 2019
✔ NPI 1972541878 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
License✔ Licensed in WA · MD00038351
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.
1909 214TH ST SE STE 300, Bothell, WA 98021
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Secondary Practice Location 1

Location 14410 106th St SWMukilteo, WA 98275 · Phone (425) 493-6001 · Fax (425) 493-6030

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Lisa Marie Ivanjack Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

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.

Medicare Billing Reassignment

Medicare enrollment records show Lisa Ivanjack reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Pacmed Clinics
3.9 mi
Multi-Specialty
19401 40TH AVE W, SUITE 100
Lynnwood, WA 98036
  • Reassigned Medicare billing, Washington enrollment
  • 291 clinicians in this Medicare group
NPI 1477594356 (425) 744-7153

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 98021 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.

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.

BERNADETH TAGLE GONZALES MD
Family Medicine
1909 214TH ST SE STE 300
BOTHELL, WA 98021
Snohomish County (425) 412-7200
DR. NHA KE TON D.O.
Family Medicine
1909 214TH ST SE STE 300
BOTHELL, WA 98021
Snohomish County (425) 412-7200
MARLENE J GRAVES FNP-C
Nurse Practitioner
1909 214TH ST SE STE 300
BOTHELL, WA 98021
Snohomish County (206) 505-1040
DR. KERLAN PETER WOLSEY M.D.
Internal Medicine (Pulmonary Disease)
1909 214TH ST SE STE 300
BOTHELL, WA 98021
Snohomish County (425) 412-7200
JULIA NADINE WILSON PA-C
Physician Assistant
1909 214TH ST SE STE 300
BOTHELL, WA 98021
Snohomish County (425) 412-7200
XING FU MD
Anesthesiology (Pain Medicine)
1909 214TH ST SE STE 300
BOTHELL, WA 98021
Snohomish County (425) 412-7200
MEGAN JONES
Physical Therapist
1909 214TH ST SE STE 300
BOTHELL, WA 98021
Snohomish County (425) 412-7200
STACY MICHELLE STORY MSW, LCSW, LICSW
Social Worker
1909 214TH ST SE STE 300
BOTHELL, WA 98021
Snohomish County (425) 412-7200

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 Lisa Ivanjack's NPI number?

The NPI number for Lisa Ivanjack is 1972541878. It was assigned to this individual provider in the NPPES registry on June 3, 2006.

Where is Lisa Ivanjack located?

Lisa Ivanjack practices at 1909 214th St SE Ste 300, Bothell, WA 98021. The listed phone number is (425) 412-7200.

What is Lisa Ivanjack's specialty?

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

Is Lisa Ivanjack enrolled in Medicare?

Yes. Lisa Ivanjack is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Lisa Ivanjack's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Lisa Ivanjack reassigns Medicare benefits to Pacmed Clinics (Lynnwood, WA). The 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 Lisa Ivanjack's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Lisa Ivanjack was last updated on September 24, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 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.