Organization Active NPI

Yelm Family Medicine, PLLC

  • Family Medicine Physician
  • Yelm, WA
National Provider Identifier
1053364950
Registry record updated Jul 31, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
YELM FAMILY MEDICINE, PLLC
Practice address
201 Tahoma Blvd
Suite 102
Yelm, WA 98597-7735
Phone
(360) 458-7761
Fax
(360) 458-8316
NPI assigned
May 19, 2006
Last updated
Jul 31, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 31, 2025

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

Authorized official

Name
Brenda E Longmire
Title
Manager
Phone
(360) 458-7761

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

201 Tahoma Blvd
Suite 102
Yelm, WA 98597-7735

Mailing address

201 Tahoma Blvd SE
Suite 102
Yelm, WA 98597
Phone (360) 458-7761

Other identifiers 2

IdentifierTypeStateIssuer
62140OtherWAL&I
7068828MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040323000860 WA Part B Supplier - Clinic/Group Practice 6608767280 Receives reassigned benefits from 12 practitioners
Practice locations: Yelm, WA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
50D0637291Yelm Family Medicine201 Tahoma Blvd Unit 102, Yelm, WA 98597Certificate of waiverApr 4, 2028

National Provider Directory

National Provider Directory

Locations

201 Tahoma Blvd
Yelm, WA 98597
Phone (360) 413-8250

201 Tahoma Blvd
Unit 102
Yelm, WA 98597
Phone (360) 458-7761

Practitioners & affiliated clinicians

Practitioners 13

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.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1147996800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1753920000000",
    "number": "1053364950",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 TAHOMA BLVD SE",
            "address_2": "SUITE 102",
            "city": "YELM",
            "state": "WA",
            "postal_code": "98597",
            "telephone_number": "360-458-7761",
            "fax_number": "360-458-6612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 TAHOMA BLVD",
            "address_2": "SUITE 102",
            "city": "YELM",
            "state": "WA",
            "postal_code": "985977735",
            "telephone_number": "360-458-7761",
            "fax_number": "360-458-8316"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "YELM FAMILY MEDICINE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-19",
        "last_updated": "2025-07-31",
        "certification_date": "2025-07-31",
        "status": "A",
        "authorized_official_last_name": "LONGMIRE",
        "authorized_official_first_name": "BRENDA",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "360-458-7761"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "L&I",
            "identifier": "62140",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7068828",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Yelm, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.