NPIMap

Organization Active NPI

Stacey L. Hiles, M.D., PLLC

  • Primary Care Clinic/Center
  • Renton, WA
National Provider Identifier
1093963795
Registry record updated Dec 27, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
60021347 Issued in WA
Legal business name
STACEY L. HILES, M.D., PLLC
Practice address
17900 Talbot Rd S
Suite 101
Renton, WA 98055-8212
Phone
(425) 235-9614
Fax
(425) 235-1060
NPI assigned
Sep 5, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 27, 2008

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

Authorized official

Name
Dr. Stacey L. Hiles, M.D.NPI 1922266162
Title
Family Practice Physician
Phone
(425) 235-9614

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X 60021347 WA Primary

Addresses

Primary practice location

17900 Talbot Rd S
Suite 101
Renton, WA 98055-8212

Mailing address

17900 Talbot Rd S
Suite 101
Renton, WA 98055-8212
Phone (425) 235-9614

Other identifiers 1

IdentifierTypeStateIssuer
1126143MedicaidWA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080923000200 WA Part B Supplier - Clinic/Group Practice 1850468570 Receives reassigned benefits from 3 practitioners
Practice locations: Renton, WA; Puyallup, WA; Kent, WA

National Provider Directory

National Provider Directory

Locations

22410 Benson Rd SE
Kent, WA 98031
Phone (253) 852-7755

17900 Talbot Rd S
Ste 101
Renton, WA 98055
Phone (425) 235-9614

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1220572800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1230336000000",
    "number": "1093963795",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17900 TALBOT RD S",
            "address_2": "SUITE 101",
            "city": "RENTON",
            "state": "WA",
            "postal_code": "980558212",
            "telephone_number": "425-235-9614",
            "fax_number": "425-235-1060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17900 TALBOT RD S",
            "address_2": "SUITE 101",
            "city": "RENTON",
            "state": "WA",
            "postal_code": "980558212",
            "telephone_number": "425-235-9614",
            "fax_number": "425-235-1060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STACEY L. HILES, M.D., PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-09-05",
        "last_updated": "2008-12-27",
        "status": "A",
        "authorized_official_last_name": "HILES",
        "authorized_official_first_name": "STACEY",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "FAMILY PRACTICE PHYSICIAN",
        "authorized_official_telephone_number": "425-235-9614",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "WA",
            "license": "60021347",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1126143",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Renton, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.