Individual provider Active NPI

Eric B Tulley, M.D.

  • Emergency Medicine Physician
  • Puyallup, WA
National Provider Identifier
1104853506
Registry record updated Jun 27, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
MD00042500 Issued in WA
Practice address
407 14TH Ave SE
Puyallup, WA 98372-3770
Phone
(253) 848-6661
Fax
(253) 770-5990
NPI assigned
Jun 28, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 27, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X MD00042500 WA Primary

Addresses

Primary practice location

407 14TH Ave SE
Puyallup, WA 98372-3770

Mailing address

PO Box 662050
Arcadia, CA 91066-2050
Phone (626) 447-0296

Other identifiers 1

IdentifierTypeStateIssuer
8378333MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in HI, OR2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20040310001570 HI Practitioner - Emergency Medicine 5395647184 Reassigns benefits to 1 organization
I20230804002909 OR Practitioner - Emergency Medicine 5395647184 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
University of Texas Medical Branch at Galveston, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Good Shepherd Health Care SystemGroup PAC ID 9133033764, 125 clinicians

Practice addresses (Care Compare)

610 NW 11TH St
Hermiston, OR 97838-6601
Phone (541) 667-3400

Hospital & facility affiliations

  • Good Shepherd Medical Center Hospital, Hermiston, OR, CCN 381325

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD00042500WAMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Kauai Medical Clinic CurrentSince Aug 15, 2017 Accepting new patients
Good Shepherd Health Care System CurrentSince Jun 25, 2023 Accepting new patients
Kauai Medical Clinic CurrentSince Aug 15, 2017 Accepting new patients
Midpacific Hospitalists LLC Past Accepting new patients
Hawaii Emergency Physicians Associated Inc Emergency Medicine Past Accepting new patients

Locations

3-3420 Kuhio Hwy
Ste B
Lihue, HI 96766
Phone (808) 245-1500

3-3420 Kuhio Hwy
Ste B
Lihue, HI 96766
Phone (808) 245-1500

610 NW 11th St
Hermiston, OR 97838
Phone (541) 667-3400

600 NW 11th St
Ste E37
Hermiston, OR 97838
Phone (541) 567-5305

Interoperability endpoints

  • Direct secure messaging: etulley1392068@direct.lhs.org

Organizations & group practices 5

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

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1151452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1214524800000",
    "number": "1104853506",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 662050",
            "city": "ARCADIA",
            "state": "CA",
            "postal_code": "910662050",
            "telephone_number": "626-447-0296",
            "fax_number": "626-447-6057"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "407 14TH AVE SE",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983723770",
            "telephone_number": "253-848-6661",
            "fax_number": "253-770-5990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TULLEY",
        "first_name": "ERIC",
        "middle_name": "B",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-28",
        "last_updated": "2008-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "WA",
            "license": "MD00042500",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8378333",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Puyallup, WA

Sources for this page

Verify at the official NPI Registry.