Individual provider Active NPI

Cornelius W Vanniel, MD

  • Pediatrics Physician
  • Seattle, WA
National Provider Identifier
1023163102
Registry record updated Nov 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
MD00037681 Issued in WA
Practice address
8720 14TH Ave S
Seattle, WA 98108-4807
Phone
(206) 762-3730
Fax
(206) 764-0523
NPI assigned
Jan 25, 2007
Last updated
Nov 27, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 27, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X MD00037681 WA Primary

Addresses

Primary practice location

8720 14TH Ave S
Seattle, WA 98108-4807

Mailing address

PO Box 34703
Seattle, WA 98124-1703

Other identifiers 1

IdentifierTypeStateIssuer
1000679MedicaidWA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180608000445 WA Practitioner - Family Practice 5991060287 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Sea Mar Community Health Centers Current Accepting new patients
Sea Mar Community Health Centers Pediatrics CurrentSince Apr 30, 2018 Accepting new patients
Sea Mar Community Health Centers CurrentSince Apr 30, 2018 Accepting new patients
Sea-Mar Community Health Center Past Accepting new patients

Locations

17707 W Main St
Fl 1
Monroe, WA 98272
Phone (360) 282-3885

8720 14th Ave S
Seattle, WA 98108
Phone (206) 762-3730

1112 S Cushman Ave
Tacoma, WA 98405
Phone (253) 593-2144

Interoperability endpoints

  • Direct secure messaging: cvanniel450926@direct.multicare.org
  • Direct secure messaging: cvanniel6621@direct.seattlechildrens.org

Ownership & related parties

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Seattle Indian Health BoardSeattle, WA, CCN 501024 Federally qualified health center Corporate Director Jun 1, 1997
Seattle Indian Health BoardSeattle, WA, CCN 501025 Federally qualified health center Corporate Director Jun 1, 1997

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1169683200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701043200000",
    "number": "1023163102",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 34703",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981241703"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8720 14TH AVE S",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981084807",
            "telephone_number": "206-762-3730",
            "fax_number": "206-764-0523"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANNIEL",
        "first_name": "CORNELIUS",
        "middle_name": "W",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-25",
        "last_updated": "2023-11-27",
        "certification_date": "2023-11-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "WA",
            "license": "MD00037681",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1000679",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Seattle, WA

Sources for this page

Verify at the official NPI Registry.