Active NPI
Susan Willis, MD
- Psychiatry Physician
- Seattle, WA
National Provider Identifier
1043315187
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- MD00028003
- Practice address
- 3123 Fairview Ave E
Seattle, WA 98102-3051 - Phone
- (206) 324-4500
- Fax
- (206) 328-1257
- NPI assigned
- Sep 13, 2006
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | MD00028003 | WA | Primary |
Addresses
Primary practice location
3123 Fairview Ave E
Seattle, WA 98102-3051
Mailing address
3123 Fairview Ave E
Seattle, WA 98102-3051
Phone (206) 324-4500
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1066174 | Medicaid | WA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Oct 1, 2015 through Oct 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD00028003 | WA | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158105600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1043315187",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3123 FAIRVIEW AVE E",
"city": "SEATTLE",
"state": "WA",
"postal_code": "981023051",
"telephone_number": "206-324-4500",
"fax_number": "206-328-1257"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3123 FAIRVIEW AVE E",
"city": "SEATTLE",
"state": "WA",
"postal_code": "981023051",
"telephone_number": "206-324-4500",
"fax_number": "206-328-1257"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLIS",
"first_name": "SUSAN",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-09-13",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "WA",
"license": "MD00028003",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1066174",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Seattle, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.