NPIMap

Organization Active NPI

Richmond Pediatric Clinic Inc. P.S.

  • Pediatrics Physician
  • Shoreline, WA
National Provider Identifier
1114962446
Registry record updated Jun 10, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
MD00038513 Issued in WA
Legal business name
RICHMOND PEDIATRIC CLINIC INC. P.S.
Practice address
357 NW Richmond Beach Rd
Richmond Pediatrics
Shoreline, WA 98177
Phone
(206) 546-2421
Fax
(206) 542-9028
NPI assigned
Jun 19, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2015

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

Authorized official

Name
Dr. Jeffrey C Ernst, MDNPI 1790721736
Title
Secty/Treas
Phone
(206) 546-2421

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 208000000X
Pediatrics PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 208000000X MD00038513 WA Primary

Addresses

Primary practice location

357 NW Richmond Beach Rd
Richmond Pediatrics
Shoreline, WA 98177

Mailing address

357 NW Richmond Beach Rd
Richmond Pediatrics
Shoreline, WA 98177
Phone (206) 546-2421

Other identifiers 2

IdentifierTypeStateIssuer
7039175MedicaidWA
8253270MedicaidWA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20141205001787 WA Part B Supplier - Clinic/Group Practice 3173845989 Receives reassigned benefits from 2 practitioners
Practice locations: Mountlake Terrace, WA

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

357 NW Richmond Beach Rd
Shoreline, WA 98177
Phone (206) 546-2421

Practitioners & affiliated clinicians

Practitioners 11

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": "1150675200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1433894400000",
    "number": "1114962446",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "357 NW RICHMOND BEACH RD",
            "address_2": "RICHMOND PEDIATRICS",
            "city": "SHORELINE",
            "state": "WA",
            "postal_code": "98177",
            "telephone_number": "206-546-2421",
            "fax_number": "206-542-9028"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "357 NW RICHMOND BEACH RD",
            "address_2": "RICHMOND PEDIATRICS",
            "city": "SHORELINE",
            "state": "WA",
            "postal_code": "98177",
            "telephone_number": "206-546-2421",
            "fax_number": "206-542-9028"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RICHMOND PEDIATRIC CLINIC INC. P.S.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-19",
        "last_updated": "2015-06-10",
        "status": "A",
        "authorized_official_last_name": "ERNST",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "SECTY/TREAS",
        "authorized_official_telephone_number": "206-546-2421",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "WA",
            "license": "MD00038513",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7039175",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8253270",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Shoreline, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2015; 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.