Individual provider Active NPI

Risa Denenberg, ARNP

  • Family Nurse Practitioner
  • Lakewood, WA
National Provider Identifier
1306904990
Registry record updated Nov 23, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
AP60030791 Issued in WA
Practice address
4905 108TH St SW
Lakewood, WA 98499-3724
Phone
(253) 581-3075
Fax
(253) 581-3178
NPI assigned
Dec 5, 2006
Last updated
Nov 23, 2011By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 23, 2011

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X AP60030791 WA Primary
Family Nurse Practitioner 363LF0000X SPOO8438 PA
Registered Nurse 163W00000X RN60029600 WA

Addresses

Primary practice location

4905 108TH St SW
Lakewood, WA 98499-3724

Mailing address

PO Box 98886
Lakewood, WA 98496-8886
Phone (253) 581-3075

Other identifiers 1

IdentifierTypeStateIssuer
1306904990MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20081006000159 WA Practitioner - Nurse Practitioner 2163524570 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Jamestown S'Klallam TribeGroup PAC ID 2365349495, 38 clinicians

Practice addresses (Care Compare)

526 S 9TH Ave
Sequim, WA 98382-3626
Phone (360) 683-5900

808 N 5TH Ave
Sequim, WA 98382-3045
Phone (360) 683-5900

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
RN60029600WAMDRegistered Nurse
SPOO8438PAMDFamily Nurse Practitioner
AP60030791WAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Jamestown S'Klallam Tribe CurrentSince Feb 1, 2012 Accepting new patients
Jamestown S'Klallam Tribe CurrentSince Feb 1, 2012 Accepting new patients
Commonspirit Washington Past Accepting new patients

Locations

526 S 9th Ave
Sequim, WA 98382
Phone (360) 681-7755

808 N 5th Ave
Sequim, WA 98382
Phone (360) 582-4840

Interoperability endpoints

  • Direct secure messaging: rdenenberg283237@wm.providencedirect.org

Organizations & group practices 3

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 1

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": "1165276800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1322006400000",
    "number": "1306904990",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 98886",
            "city": "LAKEWOOD",
            "state": "WA",
            "postal_code": "984968886",
            "telephone_number": "253-581-3075",
            "fax_number": "253-581-3178"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4905 108TH ST SW",
            "city": "LAKEWOOD",
            "state": "WA",
            "postal_code": "984993724",
            "telephone_number": "253-581-3075",
            "fax_number": "253-581-3178"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DENENBERG",
        "first_name": "RISA",
        "credential": "ARNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-12-05",
        "last_updated": "2011-11-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WA",
            "license": "AP60030791",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "PA",
            "license": "SPOO8438",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "WA",
            "license": "RN60029600",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1306904990",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lakewood, WA

Sources for this page

Verify at the official NPI Registry.