NPIMap

Organization Active NPI

Quality Care Medical Clinic,LLC

  • Family Medicine Physician
  • Yakima, WA
National Provider Identifier
1285738799
Registry record updated Apr 13, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
QUALITY CARE MEDICAL CLINIC,LLC
Practice address
611 N 39TH Ave
Yakima, WA 98902-6348
Phone
(509) 249-1288
Fax
(509) 249-6249
NPI assigned
Sep 13, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 13, 2015

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

Authorized official

Name
Dr. Larry H Keller, DC
Title
Member
Phone
(509) 249-1288

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

611 N 39TH Ave
Yakima, WA 98902-6348

Mailing address

611 N 39TH Ave
Yakima, WA 98902-6348
Phone (509) 249-1288

Other identifiers 1

IdentifierTypeStateIssuer
7094048MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040219000438 WA Part B Supplier - Clinic/Group Practice 3274428008 Receives reassigned benefits from 4 practitioners
Practice locations: Yakima, WA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 12

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": "1158105600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1428883200000",
    "number": "1285738799",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "611 N 39TH AVE",
            "city": "YAKIMA",
            "state": "WA",
            "postal_code": "989026348",
            "telephone_number": "509-249-1288",
            "fax_number": "509-249-6249"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "611 N 39TH AVE",
            "city": "YAKIMA",
            "state": "WA",
            "postal_code": "989026348",
            "telephone_number": "509-249-1288",
            "fax_number": "509-249-6249"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "QUALITY CARE MEDICAL CLINIC,LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-13",
        "last_updated": "2015-04-13",
        "status": "A",
        "authorized_official_last_name": "KELLER",
        "authorized_official_first_name": "LARRY",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "509-249-1288",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7094048",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Yakima, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.