NPIMap

Organization Active NPI

Plateau Family Medicine, PS

  • Family Medicine Physician
  • Enumclaw, WA
National Provider Identifier
1033222146
Registry record updated Jul 22, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
602444776 Issued in WA
Legal business name
PLATEAU FAMILY MEDICINE, PS
Practice address
853 Watson St N Ste 200
Enumclaw, WA 98022-9348
Phone
(360) 825-8300
Fax
(360) 825-9255
NPI assigned
Aug 16, 2006
Last updated
Jul 22, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 22, 2009

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

Authorized official

Name
Deidre L Feeney, MD
Title
Owner
Phone
(360) 825-8300

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 602444776 WA Primary

Addresses

Primary practice location

853 Watson St N Ste 200
Enumclaw, WA 98022-9348

Mailing address

853 Watson St N Ste 200
Enumclaw, WA 98022-9348
Phone (360) 825-8300

Other identifiers 1

IdentifierTypeStateIssuer
7127053MedicaidWA

National Provider Directory

National Provider Directory

Locations

853 Watson St N
Ste 200
Enumclaw, WA 98022
Phone (360) 367-2970

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1155686400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1248220800000",
    "number": "1033222146",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "853 WATSON ST N STE 200",
            "city": "ENUMCLAW",
            "state": "WA",
            "postal_code": "980229348",
            "telephone_number": "360-825-8300",
            "fax_number": "360-825-9255"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "853 WATSON ST N STE 200",
            "city": "ENUMCLAW",
            "state": "WA",
            "postal_code": "980229348",
            "telephone_number": "360-825-8300",
            "fax_number": "360-825-9255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PLATEAU FAMILY MEDICINE, PS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-16",
        "last_updated": "2009-07-22",
        "status": "A",
        "authorized_official_last_name": "FEENEY",
        "authorized_official_first_name": "DEIDRE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "360-825-8300",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "602444776",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7127053",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Enumclaw, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.