Individual provider Active NPI

Timothy Joseph Riley, CRNA

  • Certified Registered Nurse Anesthetist
  • Bellevue, WA
National Provider Identifier
1093994006
Registry record updated Jun 7, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
RN253366 Issued in MA
Practice address
11511 NE 10TH St
Bellevue, WA 98004-8578
Phone
(425) 502-3000
Fax
(425) 502-3589
NPI assigned
Oct 25, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 7, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X RN253366 MA Primary

Addresses

Primary practice location

11511 NE 10TH St
Bellevue, WA 98004-8578

Mailing address

243 Charles St
Boston, MA 02114-3002
Phone (617) 573-3380

Other practice location 1

243 Charles St
Boston, MA 02114-3002
Phone (617) 573-3380

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwa.kp.org:14430/Interconnect-CE-PRD/wcf/epic.community.hie/xcpdrespondinggatewaysync Health Information Exchange (HIE)

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20201110001544 WA Practitioner - Certified Registered Nurse Anesthetist (Crna) 3971671546 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
3541CAMDOccupational Therapy Assistant
RN253366MAMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Kaiser Foundation Health Plan of Washington CurrentSince Nov 4, 2020 Accepting new patients
Kaiser Foundation Health Plan of Washington Current Accepting new patients
Lake Washington Anesthesia PLLC Nurse Anesthetist, Certified Registered CurrentSince Nov 8, 2024 Accepting new patients
Kaiser Foundation Health Plan of Washington CurrentSince Nov 4, 2020 Accepting new patients

Locations

21600 Highway 99
Ste 260
Edmonds, WA 98026
Phone (425) 774-2650

11511 NE 10th St
Hunts Point, WA 98004
Phone (425) 502-3000

11800 NE 128th St
Ste 100
Kirkland, WA 98034
Phone (425) 899-4500

200 15th Ave E
Seattle, WA 98112
Phone (206) 326-4530

501 N 34th St
Ste 101
Seattle, WA 98103
Phone (206) 838-1777

9505 S Steele St
Tacoma, WA 98444
Phone (253) 597-6800

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1193270400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623024000000",
    "number": "1093994006",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "243 CHARLES ST",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021143002",
            "telephone_number": "617-573-3380"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11511 NE 10TH ST",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980048578",
            "telephone_number": "425-502-3000",
            "fax_number": "425-502-3589"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "243 Charles St",
            "address_purpose": "LOCATION",
            "city": "Boston",
            "state": "MA",
            "postal_code": "021143002",
            "country_code": "US",
            "telephone_number": "617-573-3380",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RILEY",
        "first_name": "TIMOTHY",
        "middle_name": "JOSEPH",
        "name_prefix": "Mr.",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-10-25",
        "last_updated": "2021-06-07",
        "certification_date": "2021-06-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MA",
            "license": "RN253366",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwa.kp.org:14430/Interconnect-CE-PRD/wcf/epic.community.hie/xcpdrespondinggatewaysync",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "11511 NE 10th St",
            "city": "Bellevue",
            "state": "WA",
            "country_code": "US",
            "postal_code": "980048578",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Bellevue, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2021; 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.