Individual provider Active NPI

Maurene P Cronyn, M.D.

  • Family Medicine Physician
  • Edmonds, WA
National Provider Identifier
1326099078
Registry record updated Mar 18, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD00020736 Issued in WA
Practice address
21911 76TH Ave W
#110
Edmonds, WA 98026-7903
Phone
(425) 640-4950
Fax
(425) 640-4958
NPI assigned
May 15, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 18, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MD00020736 WA Primary

Addresses

Primary practice location

21911 76TH Ave W
#110
Edmonds, WA 98026-7903

Mailing address

21911 76TH Ave W
#110
Edmonds, WA 98026-7903
Phone (425) 640-4950

Other identifiers 2

IdentifierTypeStateIssuer
1090976MedicaidWA
R06641OtherWAREGENCE BLUE SHIELD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD00020736WAMDFamily Medicine Physician

Interoperability endpoints

  • Direct secure messaging: mcronyn1041401@wm.providencedirect.org

NPI Registry JSON

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

{
    "created_epoch": "1147651200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1268870400000",
    "number": "1326099078",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21911 76TH AVE W",
            "address_2": "#110",
            "city": "EDMONDS",
            "state": "WA",
            "postal_code": "980267903",
            "telephone_number": "425-640-4950",
            "fax_number": "425-640-4958"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21911 76TH AVE W",
            "address_2": "#110",
            "city": "EDMONDS",
            "state": "WA",
            "postal_code": "980267903",
            "telephone_number": "425-640-4950",
            "fax_number": "425-640-4958"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CRONYN",
        "first_name": "MAURENE",
        "middle_name": "P",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-15",
        "last_updated": "2010-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "MD00020736",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1090976",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE BLUE SHIELD",
            "identifier": "R06641",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Edmonds, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2010; 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.