NPIMap

Organization Active NPI

Renovo Medical Group

  • Adult Medicine Physician
  • Shoreline, WA
National Provider Identifier
1275931982
Registry record updated Jun 20, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Medicine PhysicianTaxonomy code 207QA0505X
Legal business name
RENOVO MEDICAL GROUP
Practice address
19930 Ballinger Way NE
Shoreline, WA 98155-1223
Phone
(425) 778-2220
NPI assigned
Dec 11, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 20, 2018

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

Authorized official

Name
Cheryl Hamill
Title
Operations Manager
Phone
(425) 778-2220

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207QA0505X Primary
Obesity Medicine (Family Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207QB0002X
Sleep Medicine (Family Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207QS1201X
Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208600000X

Addresses

Primary practice location

19930 Ballinger Way NE
Shoreline, WA 98155-1223

Mailing address

19930 Ballinger Way NE
Shoreline, WA 98155-1223
Phone (425) 778-2220

National Provider Directory

National Provider Directory

Locations

21920 76th Ave W
Ste 104
Edmonds, WA 98026

11216 Sunrise Blvd E
Ste 209
Puyallup, WA 98374

19930 Ballinger Way NE
Shoreline, WA 98155
Phone (206) 363-6947

Practitioners & affiliated clinicians

Practitioners 4

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": "1418256000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529452800000",
    "number": "1275931982",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19930 BALLINGER WAY NE",
            "city": "SHORELINE",
            "state": "WA",
            "postal_code": "981551223",
            "telephone_number": "425-778-2220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19930 BALLINGER WAY NE",
            "city": "SHORELINE",
            "state": "WA",
            "postal_code": "981551223",
            "telephone_number": "425-778-2220"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RENOVO MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-11",
        "last_updated": "2018-06-20",
        "status": "A",
        "authorized_official_last_name": "HAMILL",
        "authorized_official_first_name": "CHERYL",
        "authorized_official_title_or_position": "OPERATIONS MANAGER",
        "authorized_official_telephone_number": "425-778-2220"
    },
    "taxonomies": [
        {
            "code": "207QA0505X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Adult Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207QB0002X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Obesity Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207QS1201X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Sleep Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Shoreline, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2018; 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.