Jon M Tippin, MD

Primary specialty

Neurology PhysicianTaxonomy code 2084N0400X

License

00022815 Issued in WA

Practice address

768 Taylor Rd
Kalama, WA 98625

Phone

(615) 345-5400

NPI assigned

Nov 17, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in IN

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1132185600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1582243200000",
    "number": "1073595880",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 MARYLAND FARMS STE 200",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370275005",
            "telephone_number": "615-345-5400",
            "fax_number": "888-468-6603"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "768 TAYLOR RD",
            "city": "KALAMA",
            "state": "WA",
            "postal_code": "98625",
            "telephone_number": "615-345-5400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TIPPIN",
        "first_name": "JON",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-17",
        "last_updated": "2020-02-21",
        "certification_date": "2020-02-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "NM",
            "license": "MD2019-0927",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "IA",
            "license": "23642",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "WA",
            "license": "00022815",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLMARK BCBS",
            "identifier": "37261",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0196147",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NEW MEXICO MEDICAL BOARD",
            "identifier": "MD2019-0927",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Colleen Emily Peterson, LMT
• Betsy Mae Preheim, LMP
• Colleen Marie Schaffer, LPN
• Spine Align Northwest P.C. (Spine Align Northwest)
• Jacob Stockton, D.C.

• Neurology Physician in Kalama, WA
• Providers in Kalama, WA by specialty
• Neurology Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2020; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.