NPIMap

Individual provider Active NPI

Emerisse Camille Shen, ARNP

  • Nurse Practitioner
  • Everett, WA
National Provider Identifier
1255645701
Registry record updated Jan 5, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
AP60175330 Issued in WA
Practice address
1410 Broadway
Everett, WA 98201-1720
Phone
(425) 789-2000
NPI assigned
Jul 27, 2010
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 5, 2012

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Clinic/Center 261QC1500X AP60175330 WA
Nurse Practitioner 363L00000X AP60175330 WA Primary

Addresses

Primary practice location

1410 Broadway
Everett, WA 98201-1720

Mailing address

P.O. Box 13060
Everett, WA 98206
Phone (425) 789-2000

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101104000754 WA Practitioner - Nurse Practitioner 8628262599 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

11911 NE 132ND St
Suite 200
Kirkland, WA 98034-2900
Phone (425) 899-5800

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
86.73 of 100Reported as apm
Quality
73.46
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
AP60175330WAMDCommunity Health Clinic/Center

Practice roles

OrganizationSpecialtyStatusNew patients
King County Public Hospital District No 2 Current Accepting new patients
King County Public Hospital District No 2 CurrentSince Jun 1, 2019 Accepting new patients
King County Public Hospital District No 2 Past Accepting new patients
Community Health Center of Snohomish County Past Accepting new patients
Issaquah Obstetrics and Gynecology PLLC Past Accepting new patients

Locations

6520 226th Pl SE
Ste 205
Issaquah, WA 98027
Phone (425) 392-8611

12039 NE 128th St
Ste 300
Kirkland, WA 98034
Phone (425) 899-3123

11911 NE 132nd St
Ste 200
Kirkland, WA 98034
Phone (425) 899-5800

12040 NE 128th St
#10
Kirkland, WA 98034
Phone (206) 466-0369

Organizations & group practices 5

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

Hospital & facility affiliations 4

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": "1280188800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1325721600000",
    "number": "1255645701",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 13060",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "98206",
            "telephone_number": "425-789-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1410 BROADWAY",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982011720",
            "telephone_number": "425-789-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHEN",
        "first_name": "EMERISSE",
        "middle_name": "CAMILLE",
        "name_prefix": "Mrs.",
        "credential": "ARNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-07-27",
        "last_updated": "2012-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": "WA",
            "license": "AP60175330",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WA",
            "license": "AP60175330",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Everett, WA

Sources for this page

Verify at the official NPI Registry.