NPIMap

Organization Active NPI

Eppel Family Medicine LLC

  • Geriatric Medicine (Family Medicine) Physician
  • Port Orchard, WA
National Provider Identifier
1134472947
Registry record updated Oct 17, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Family Medicine) PhysicianTaxonomy code 207QG0300X
License
1977 Issued in WA
Legal business name
EPPEL FAMILY MEDICINE LLC
Practice address
1950 Pottery Ave
Ste 140
Port Orchard, WA 98366-2592
Phone
(360) 876-5440
Fax
(360) 876-0718
NPI assigned
Oct 17, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2012

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

Authorized official

Name
Mrs. Wendie Pond
Title
Billing Manager
Phone
(360) 479-0508

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Family Medicine) PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207QG0300X 1977 WA Primary

Addresses

Primary practice location

1950 Pottery Ave
Ste 140
Port Orchard, WA 98366-2592

Mailing address

1950 Pottery Ave
Ste 140
Port Orchard, WA 98366-2592
Phone (360) 876-5440

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130313000047 WA Part B Supplier - Clinic/Group Practice 3870748122 Receives reassigned benefits from 10 practitioners
Practice locations: Port Orchard, WA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
50D2050802Eppel Family Medicine1950 Pottery Ave Ste 140, Port Orchard, WA 98366Certificate of waiverApr 4, 2028

National Provider Directory

National Provider Directory

Locations

1950 Pottery Ave
Ste 140
Port Orchard, WA 98366
Phone (360) 451-1600

Practitioners & affiliated clinicians

Practitioners 10

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": "1350432000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1350432000000",
    "number": "1134472947",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1950 POTTERY AVE",
            "address_2": "STE 140",
            "city": "PORT ORCHARD",
            "state": "WA",
            "postal_code": "983662592",
            "telephone_number": "360-876-5440",
            "fax_number": "360-876-0718"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1950 POTTERY AVE",
            "address_2": "STE 140",
            "city": "PORT ORCHARD",
            "state": "WA",
            "postal_code": "983662592",
            "telephone_number": "360-876-5440",
            "fax_number": "360-876-0718"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EPPEL FAMILY MEDICINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-17",
        "last_updated": "2012-10-17",
        "status": "A",
        "authorized_official_last_name": "POND",
        "authorized_official_first_name": "WENDIE",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "360-479-0508",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207QG0300X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": "WA",
            "license": "1977",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Orchard, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.