Emerald City Internal Medicine PLLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

MD000116322 Issued in WA

Legal business name

EMERALD CITY INTERNAL MEDICINE PLLC

Practice address

14517 60TH Ave W
Edmonds, WA 98026-3605

Phone

(206) 386-3500

Fax

(206) 386-3568

NPI assigned

Nov 21, 2006

Organization subpart

No

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

Authorized official

Name

Thomas J Smith, MD

Title

Owner

Phone

(206) 386-3500

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1164067200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1235347200000",
    "number": "1285709915",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14517 60TH AVE W",
            "city": "EDMONDS",
            "state": "WA",
            "postal_code": "980263605",
            "telephone_number": "206-386-3500",
            "fax_number": "206-386-3568"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14517 60TH AVE W",
            "city": "EDMONDS",
            "state": "WA",
            "postal_code": "980263605",
            "telephone_number": "206-386-3500",
            "fax_number": "206-386-3568"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EMERALD CITY INTERNAL MEDICINE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-21",
        "last_updated": "2009-02-23",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "206-386-3500",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "WA",
            "license": "MD000116322",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7075053",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Edmonds, WA
• Providers in Edmonds, WA by specialty
• Internal Medicine Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2009; 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.