NPIMap

Organization Active NPI

Mercer Island Pediatric Associates

  • Pediatrics Physician
  • Mercer Island, WA
National Provider Identifier
1336349422
Registry record updated Jul 18, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
MD30804 Issued in WA
Legal business name
MERCER ISLAND PEDIATRIC ASSOCIATES
Practice address
2553 76TH Ave SE
Mercer Island, WA 98040-2758
Phone
(206) 275-2122
Fax
(206) 275-0869
NPI assigned
Jul 18, 2007
Last updated
Jul 18, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 18, 2007

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

Authorized official

Name
Dr. Julie Ellner, M.D.NPI 1316925357
Title
Director
Phone
(206) 329-7512

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X MD30804 WA Primary

Addresses

Primary practice location

2553 76TH Ave SE
Mercer Island, WA 98040-2758

Mailing address

2553 76TH Ave SE
Mercer Island, WA 98040-2758
Phone (206) 275-2122

Other identifiers 1

IdentifierTypeStateIssuer
1082056MedicaidWA

National Provider Directory

National Provider Directory

Locations

2553 76th Ave SE
Mercer Island, WA 98040
Phone (206) 275-0702

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1184716800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1184716800000",
    "number": "1336349422",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2553 76TH AVE SE",
            "city": "MERCER ISLAND",
            "state": "WA",
            "postal_code": "980402758",
            "telephone_number": "206-275-2122",
            "fax_number": "206-275-0869"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2553 76TH AVE SE",
            "city": "MERCER ISLAND",
            "state": "WA",
            "postal_code": "980402758",
            "telephone_number": "206-275-2122",
            "fax_number": "206-275-0869"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MERCER ISLAND PEDIATRIC ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-18",
        "last_updated": "2007-07-18",
        "status": "A",
        "authorized_official_last_name": "ELLNER",
        "authorized_official_first_name": "JULIE",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "206-329-7512",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "WA",
            "license": "MD30804",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1082056",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mercer Island, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2007; 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.