NPIMap

Organization Active NPI

Creekside Sleep Medicine Center PLLC

  • Sleep Medicine (Internal Medicine) Physician
  • Bellevue, WA
National Provider Identifier
1154667475
Registry record updated Dec 13, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sleep Medicine (Internal Medicine) PhysicianTaxonomy code 207RS0012X
Legal business name
CREEKSIDE SLEEP MEDICINE CENTER PLLC
Practice address
1380 112TH Ave NE
#307
Bellevue, WA 98004-3759
Phone
(425) 278-2250
Fax
(425) 562-5885
NPI assigned
Dec 13, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 13, 2012

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

Authorized official

Name
Ms. Jeannein M Dieringer
Title
Office Manager
Phone
(425) 278-2228

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sleep Medicine (Internal Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RS0012X WA Primary

Addresses

Primary practice location

1380 112TH Ave NE
#307
Bellevue, WA 98004-3759

Mailing address

1380 112TH Ave NE
#307
Bellevue, WA 98004-3759
Phone (425) 278-2250

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130123000175 WA Part B Supplier - Clinic/Group Practice 8921195082 Receives reassigned benefits from 2 practitioners
Practice locations: Bellevue, WA; Issaquah, WA

National Provider Directory

National Provider Directory
Tax ID family
Creekside Sleep Medicine Center2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1380 112th Ave NE
Ste 207
Bellevue, WA 98004
Phone (425) 278-2250

3707 Providence Point Dr SE
Ste G
Issaquah, WA 98029
Phone (425) 278-2250

22525 SE 64th Pl
Fl 2
Issaquah, WA 98027

22525 SE 64th Pl
Bldg H
Issaquah, WA 98027
Phone (425) 278-2250

Practitioners & affiliated clinicians

Practitioners 3

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": "1355356800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1355356800000",
    "number": "1154667475",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1380 112TH AVE NE",
            "address_2": "#307",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980043759",
            "telephone_number": "425-278-2250",
            "fax_number": "425-562-5885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1380 112TH AVE NE",
            "address_2": "#307",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980043759",
            "telephone_number": "425-278-2250",
            "fax_number": "425-562-5885"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CREEKSIDE SLEEP MEDICINE CENTER PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-12-13",
        "last_updated": "2012-12-13",
        "status": "A",
        "authorized_official_last_name": "DIERINGER",
        "authorized_official_first_name": "JEANNEIN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "425-278-2228",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207RS0012X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Sleep Medicine",
            "state": "WA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "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 Dec 13, 2012; 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.