Mercer Island Family Medicine, PLLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

OP00002196 Issued in WA

Legal business name

MERCER ISLAND FAMILY MEDICINE, PLLC

Practice address

3003 Island Crest Way
Mercer Island, WA 98040-2998

Phone

(586) 850-4645

NPI assigned

Jun 11, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Scott Edward Fannin, D.O.

Title

President

Phone

(586) 850-4645

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Charles R Flake, MD

  • Obstetrics & Gynecology Physician
  • Mercer Is, WA
  • NPI 1548373814
  NPD (past)

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

{
    "created_epoch": "1181520000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1194928697",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "54196 KATHERINE WOOD DR",
            "city": "MACOMB",
            "state": "MI",
            "postal_code": "480422315",
            "telephone_number": "586-850-4645"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3003 ISLAND CREST WAY",
            "city": "MERCER ISLAND",
            "state": "WA",
            "postal_code": "980402998",
            "telephone_number": "586-850-4645"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MERCER ISLAND FAMILY MEDICINE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-11",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "FANNIN",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_middle_name": "EDWARD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "586-850-4645",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "OP00002196",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Meagan M Hyde, LLC
• Krista Lynn Meeks, ARNP
• Mercer Island Acupuncture & Oriental Medicine
• Mercer Island Dermatology PLLC
• Mercer Island Eyeworks Inc
• Mercer Island Foot and Ankle Clinic PLLC
• Mercer Island Health and Wellness
• Mercer Island Medical Imaging, LLC
• Mercer Island Pediatric Associates
• Mercer Island Pediatric Dentistry

• Family Medicine Physician in Mercer Island, WA
• Providers in Mercer Island, WA by specialty
• Family Medicine Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.