Individual provider Active NPI

Charles Raymond Leusner, MD

  • Vascular & Interventional Radiology Physician
  • Tacoma, WA
National Provider Identifier
1255403176
Registry record updated Aug 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular & Interventional Radiology PhysicianTaxonomy code 2085R0204X
License
MD00048416 Issued in WA
Practice address
1304 Fawcett Ave Ste 100
Tacoma, WA 98402-1900
Phone
(253) 761-4200
Fax
(253) 761-4201
NPI assigned
Nov 15, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 30, 2024

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X MD162032 OR
Diagnostic Radiology Physician 2085R0202X MD00048416 WA
Vascular & Interventional Radiology Physician 2085R0204X MD162032 OR
Vascular & Interventional Radiology Physician 2085R0204X MD00048416 WA Primary

Addresses

Primary practice location

1304 Fawcett Ave Ste 100
Tacoma, WA 98402-1900

Mailing address

PO Box 1535
Tacoma, WA 98401-1535
Phone (253) 761-4200

Other identifiers 6

IdentifierTypeStateIssuer
8945559OtherWALABOR AND INDUSTRIES CRIME VICTIMS-TRA
0225749OtherWALABOR AND INDUSTRIES-TRA
0225750OtherWALABOR AND INDUSTRIES-UNION AVENUE OPEN MRI
1091253MedicaidWA
500666603MedicaidOR
8945560OtherWALABOR AND INDUSTRIES CRIME VICTIMS-UNION AVENUE OPEN MRI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA, OR2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20071031000491 WA Practitioner - Diagnostic RadiologyPractitioner - Interventional Radiology 5890754758 Reassigns benefits to 4 organizations
I20130521000291 OR Practitioner - Diagnostic RadiologyPractitioner - Interventional Radiology 5890754758 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic RadiologyAlso: Interventional Radiology
Education
University of Washington School of Medicine, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Tra-Minw P SGroup PAC ID 2163316167, 152 clinicians

Practice addresses (Care Compare)

1304 Fawcett Ave
Suite 100
Tacoma, WA 98402-1900
Phone (253) 841-4353

222 15TH Ave SE
Puyallup, WA 98372-3754
Phone (253) 841-4353

2801 St Anthony Way
Pendleton, OR 97801-3800
Phone (253) 841-4353

Hospital & facility affiliations

  • Tacoma General Allenmore Hospital Hospital, Tacoma, WA, CCN 500129
  • Multicare Good Samaritan Hospital Hospital, Puyallup, WA, CCN 500079
  • St Joseph Medical Center Hospital, Tacoma, WA, CCN 500108
  • St Francis Community Hospital Hospital, Federal Way, WA, CCN 500141
  • St Anthony Hospital Hospital, Gig Harbor, WA, CCN 500151

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD162032ORMDVascular & Interventional Radiology Physician
MD00048416WAMDVascular & Interventional Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Tra-Minw P S CurrentSince Aug 1, 2007 Accepting new patients
Tra-Minw P S CurrentSince Aug 1, 2007 Accepting new patients
Tra Medical Imaging Centers LLC CurrentSince Dec 1, 2025 Accepting new patients
Medical Imaging Northwest - Good Samaritan Hospital Imaging Alliance CurrentSince Mar 1, 2017 Accepting new patients
Union Avenue Open MRI LLC CurrentSince Aug 2, 2007 Accepting new patients
Tra-Minw, PS Diagnostic Radiology CurrentSince Apr 1, 2013 Accepting new patients
Medical Imaging Northwest - Good Samaritan Hospital Imaging Alliance CurrentSince Mar 1, 2017 Accepting new patients
Medical Imaging Northwest - Good Samaritan Hospital Imaging Alliance Past Accepting new patients

Locations

2801 St Anthony Way
Pendleton, OR 97801
Phone (541) 276-5121

122 3rd St NE
Auburn, WA 98002
Phone (253) 833-7750

21110 Sr 410 E
Ste 110
Bonney Lake, WA 98391

5900 State Highway 303 NE
Bremerton, WA 98311
Phone (253) 459-6633

2512 Wheaton Way
Bremerton, WA 98310
Phone (360) 782-3650

2512 Wheaton Way
#O
Bremerton, WA 98310
Phone (360) 782-3700

33915 1st Way S
Ste 130
Federal Way, WA 98003
Phone (253) 528-9135

34515 9th Ave S
Federal Way, WA 98003
Phone (253) 835-8100

4700 Point Fosdick Dr
Ste 110
Gig Harbor, WA 98335
Phone (253) 759-2622

9725 SE 36th St
Ste 114
Mercer Island, WA 98040

500 Lilly Rd NE
Ste 160
Olympia, WA 98506
Phone (360) 413-8307

222 15th Ave SE
Puyallup, WA 98372

11212 Sunrise Blvd E
Ste 200
Puyallup, WA 98374

3400 California Ave SW
Seattle, WA 98116
Phone (206) 320-3399

1304 Fawcett Ave
Ste 100
Tacoma, WA 98402
Phone (253) 680-3372

9601 Steilacoom Blvd SW
Tacoma, WA 98498
Phone (253) 582-8900

3402 S 18th St
Tacoma, WA 98405
Phone (253) 383-1099

2502 S Union Ave
Tacoma, WA 98405
Phone (253) 759-5900

5919 100th St SW
Tacoma, WA 98499

Interoperability endpoints

  • FHIR API: https://app.meldrx.com/api/fhir/ei-trami

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 9

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1163548800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724976000000",
    "number": "1255403176",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1535",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984011535",
            "telephone_number": "253-761-4200",
            "fax_number": "253-383-3553"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1304 FAWCETT AVE STE 100",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984021900",
            "telephone_number": "253-761-4200",
            "fax_number": "253-761-4201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEUSNER",
        "first_name": "CHARLES",
        "middle_name": "RAYMOND",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-15",
        "last_updated": "2024-08-30",
        "certification_date": "2024-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "OR",
            "license": "MD162032",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "WA",
            "license": "MD00048416",
            "primary": false
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "OR",
            "license": "MD162032",
            "primary": false
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "WA",
            "license": "MD00048416",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LABOR AND INDUSTRIES CRIME VICTIMS-TRA",
            "identifier": "8945559",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LABOR AND INDUSTRIES-TRA",
            "identifier": "0225749",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LABOR AND INDUSTRIES-UNION AVENUE OPEN MRI",
            "identifier": "0225750",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1091253",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500666603",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LABOR AND INDUSTRIES CRIME VICTIMS-UNION AVENUE OPEN MRI",
            "identifier": "8945560",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tacoma, WA

Sources for this page

Verify at the official NPI Registry.