Active NPI
Jerome L Bushnell, MD
- Family Medicine Physician
- Issaquah, WA
National Provider Identifier
1033149307
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- MD00017470
- Practice address
- 100 NE Gilman Blvd
Issaquah, WA 98027-2925 - Phone
- (425) 557-8000
- Fax
- (425) 557-8014
- NPI assigned
- Jul 3, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | MD00017470 | WA | Primary |
Addresses
Primary practice location
100 NE Gilman Blvd
Issaquah, WA 98027-2925
Mailing address
1100 Olive Way MSC M4-PA
Seattle, WA 98101-1873
Phone (206) 515-5811
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 080067829 | Other | RAILROAD MEDICARE | |
| B870 | Other | WA | BLUE SHIELD |
| 0039581 | Other | WA | LABOR & INDUSTRY |
| 175072 | Medicaid | WA | |
| US0818823 | Other | WA | AETNA/USHC PCP |
| US4119870 | Other | WA | AETNA/USHC SPECIALIST |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Interoperability endpoints
- jerome.bushnell@direct.vmmc.org
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151884800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1295913600000",
"number": "1033149307",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1100 OLIVE WAY MSC M4-PA",
"city": "SEATTLE",
"state": "WA",
"postal_code": "981011873",
"telephone_number": "206-515-5811"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 NE GILMAN BLVD",
"city": "ISSAQUAH",
"state": "WA",
"postal_code": "980272925",
"telephone_number": "425-557-8000",
"fax_number": "425-557-8014"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BUSHNELL",
"first_name": "JEROME",
"middle_name": "L",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-03",
"last_updated": "2011-01-25",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "WA",
"license": "MD00017470",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "080067829",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD",
"identifier": "B870",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LABOR & INDUSTRY",
"identifier": "0039581",
"state": "WA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "175072",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA/USHC PCP",
"identifier": "US0818823",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA/USHC SPECIALIST",
"identifier": "US4119870",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Issaquah, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.