Timothy Isamu O'Connor, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

MD60658842 Issued in WA

Practice address

55 W Tietan St
Walla Walla, WA 99362-4445

Phone

(509) 525-3720

NPI assigned

Mar 28, 2013

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in WA

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

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: timothy.o.connor.1@28594.direct.athenahealth.com
• FHIR API: https://api.platform.athenahealth.com/28594/brand/1/csg/1/fhir/r4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Privia Medical Group Washington, PLLC

  dba Walla Walla Clinic (Professional)

  • Clinic/Center
  • Walla Walla, WA
  • NPI 1780658419
  Medicare reassignment NPD
• Walla Walla Clinic, Inc.

  dba Walla Walla Clinic Ambulatory Surgery Center

  • Ambulatory Surgical Clinic/Center
  • Walla Walla, WA
  • NPI 1760568273
  NPD
• Walla Walla Clinic, Inc.

  dba Walla Walla Clinic Milton-Freewater

  • Clinic/Center
  • Milton Freewater, OR
  • NPI 1063521862
  NPD
• Providence Health & Services - Washington

  dba Providence St Mary Medical Center

  • General Acute Care Hospital
  • Walla Walla, WA
  • NPI 1386895886
  NPD (past)

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

{
    "created_epoch": "1364428800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1464825600000",
    "number": "1073856043",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 W TIETAN ST",
            "city": "WALLA WALLA",
            "state": "WA",
            "postal_code": "993624445",
            "telephone_number": "509-525-3720"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 W TIETAN ST",
            "city": "WALLA WALLA",
            "state": "WA",
            "postal_code": "993624445",
            "telephone_number": "509-525-3720"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "O'CONNOR",
        "first_name": "TIMOTHY",
        "middle_name": "ISAMU",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-03-28",
        "last_updated": "2016-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "WA",
            "license": "ML60368579",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "WA",
            "license": "MD60658842",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Norco, Inc
• Jeremiah Nordstrom
• Benjamin Norens
• Rosemary Norheim, MSW, LMHC
• Northwest Counseling Solutions
• Lisa L O'Dell
• Thomas John O'Donnell, PT, DPT, OCS
• Stacy Samantha Ochoa-Sofoifa, ARNP, DNP-FNP-C
• Jennifer Lynn Oetman, LICSW
• Taylor Offerdahl-Church

• Pediatrics Physician in Walla Walla, WA
• Providers in Walla Walla, WA by specialty
• Pediatrics Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2016; 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.