Organization Active NPI

Kim Pruess Nevins MD PLLC

  • Internal Medicine Physician
  • Issaquah, WA
National Provider Identifier
1255311122
Registry record updated May 31, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD00038616 Issued in WA
Legal business name
KIM PRUESS NEVINS MD PLLC
Practice address
450 NW Gilman Blvd
Ste 301a
Issaquah, WA 98027
Phone
(425) 391-0313
Fax
(425) 837-8501
NPI assigned
Jan 18, 2006
Last updated
May 31, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 31, 2011

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

Authorized official

Name
Kim Elizabeth Pruess Nevins, MDNPI 1982684833
Title
MD Owner
Phone
(425) 391-0313

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD00038616 WA Primary

Addresses

Primary practice location

450 NW Gilman Blvd
Ste 301a
Issaquah, WA 98027

Mailing address

PO Box 1225
Issaquah, WA 98027-0047
Phone (425) 391-0313

Other identifiers 1

IdentifierTypeStateIssuer
DC8003OtherRAILROAD MEDICARE

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1137542400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1306800000000",
    "number": "1255311122",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1225",
            "city": "ISSAQUAH",
            "state": "WA",
            "postal_code": "980270047",
            "telephone_number": "425-391-0313",
            "fax_number": "425-837-8501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "450 NW GILMAN BLVD",
            "address_2": "STE 301A",
            "city": "ISSAQUAH",
            "state": "WA",
            "postal_code": "98027",
            "telephone_number": "425-391-0313",
            "fax_number": "425-837-8501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIM PRUESS NEVINS MD PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-18",
        "last_updated": "2011-05-31",
        "status": "A",
        "authorized_official_last_name": "PRUESS NEVINS",
        "authorized_official_first_name": "KIM",
        "authorized_official_middle_name": "ELIZABETH",
        "authorized_official_title_or_position": "MD OWNER",
        "authorized_official_telephone_number": "425-391-0313",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WA",
            "license": "MD00038616",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DC8003",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Issaquah, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2011; 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.