NPIMap

Individual provider Active NPI

Scott Randall Henneman, MD

  • Diagnostic Radiology Physician
  • Tacoma, WA
National Provider Identifier
1013173814
Registry record updated Aug 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
MD60392348 Issued in WA
Practice address
1304 Fawcett Ave Ste 100
Tacoma, WA 98402
Phone
(253) 761-4200
Fax
(253) 761-4201
NPI assigned
Jul 31, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 30, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Neuroradiology Physician 2085N0700X MD60392348 WA
Diagnostic Radiology Physician 2085R0202X MD187713 OR
Neuroradiology Physician 2085N0700X MD187713 OR
Diagnostic Radiology Physician 2085R0202X MD60392348 WA Primary

Addresses

Primary practice location

1304 Fawcett Ave Ste 100
Tacoma, WA 98402

Mailing address

1304 Fawcett Ave Ste 100
Tacoma, WA 98402-1900
Phone (253) 761-4200

Other identifiers 1

IdentifierTypeStateIssuer
2029105MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140709000579 WA Practitioner - Diagnostic Radiology 0840415717 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Columbia University College of Physicians and Surgeons, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Tra-Minw P SGroup PAC ID 2163316167, 152 clinicians

Practice addresses (Care Compare)

16251 Sylvester Rd SW
Burien, WA 98166-3017
Phone (253) 841-4353

3402 S 18TH St
Tacoma, WA 98405-1903
Phone (253) 841-4353

34515 9TH Ave S
Federal Way, WA 98003-6761
Phone (253) 841-4353

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD60392348WAMDNeuroradiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Union Avenue Open MRI LLC CurrentSince Jul 8, 2015 Accepting new patients
Tra Medical Imaging Centers LLC CurrentSince Dec 1, 2025 Accepting new patients
Medical Imaging Northwest - Good Samaritan Hospital Imaging Alliance CurrentSince Jul 8, 2014 Accepting new patients
Medical Imaging Northwest - Good Samaritan Hospital Imaging Alliance CurrentSince Jul 8, 2014 Accepting new patients
Tra-Minw P S CurrentSince Jan 1, 2017 Accepting new patients

Locations

21110 Sr 410 E
Ste 110
Bonney Lake, WA 98391

34515 9th Ave S
Federal Way, WA 98003
Phone (253) 835-8100

222 15th Ave SE
Puyallup, WA 98372

3402 S 18th St
Tacoma, WA 98405
Phone (253) 383-1099

9601 Steilacoom Blvd SW
Tacoma, WA 98498
Phone (253) 582-8900

1304 Fawcett Ave
Ste 100
Tacoma, WA 98402
Phone (253) 680-3372

2502 S Union Ave
Tacoma, WA 98405
Phone (253) 759-5900

1201 Pacific Ave
Ste 400
Tacoma, WA 98402
Phone (253) 300-8447

Interoperability endpoints

  • FHIR API: https://app.meldrx.com/api/fhir/ei-trami

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 9

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1217462400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724976000000",
    "number": "1013173814",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1304 FAWCETT AVE STE 100",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984021900",
            "telephone_number": "253-761-4200",
            "fax_number": "253-383-3553"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1304 FAWCETT AVE STE 100",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "98402",
            "telephone_number": "253-761-4200",
            "fax_number": "253-761-4201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENNEMAN",
        "first_name": "SCOTT",
        "middle_name": "RANDALL",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-07-31",
        "last_updated": "2024-08-30",
        "certification_date": "2024-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085N0700X",
            "taxonomy_group": "",
            "desc": "Radiology, Neuroradiology",
            "state": "WA",
            "license": "MD60392348",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "OR",
            "license": "MD187713",
            "primary": false
        },
        {
            "code": "2085N0700X",
            "taxonomy_group": "",
            "desc": "Radiology, Neuroradiology",
            "state": "OR",
            "license": "MD187713",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "WA",
            "license": "MD60392348",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2029105",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tacoma, WA

Sources for this page

Verify at the official NPI Registry.