Active NPI
Kim Leatham, MD
- Family Medicine Physician
- Bainbridge Island, WA
National Provider Identifier
1346352333
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- MD00027650
- Practice address
- 1344 Wintergreen LN NE
Bainbridge Island, WA 98110 - Phone
- (206) 842-5632
- Fax
- (206) 842-5992
- NPI assigned
- Aug 31, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | MD00027650 | WA | Primary |
Addresses
Primary practice location
1344 Wintergreen LN NE
Bainbridge Island, WA 98110
Mailing address
1344 Wintergreen LN NE
Bainbridge Island, WA 98110-5118
Phone (206) 842-5632
Other practice location 1
380 Winslow Way E
Bainbridge Island, WA 98110-2424
Phone (206) 842-5631
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1067594 | Medicaid | WA | |
| LE3004 | Other | WA | BLUE SHIELD |
| 0039581 | Other | WA | LABOR & INDUSTRY |
| US0899742 | Other | WA | AETNA/USHC PCP |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156982400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1528848000000",
"number": "1346352333",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1344 WINTERGREEN LN NE",
"city": "BAINBRIDGE ISLAND",
"state": "WA",
"postal_code": "981105118",
"telephone_number": "206-842-5632",
"fax_number": "206-842-5992"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1344 WINTERGREEN LN NE",
"city": "BAINBRIDGE ISLAND",
"state": "WA",
"postal_code": "98110",
"telephone_number": "206-842-5632",
"fax_number": "206-842-5992"
}
],
"practiceLocations": [
{
"address_1": "380 Winslow Way E",
"address_purpose": "LOCATION",
"city": "Bainbridge Island",
"state": "WA",
"postal_code": "981102424",
"country_code": "US",
"telephone_number": "206-842-5631",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "LEATHAM",
"first_name": "KIM",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-31",
"last_updated": "2018-06-13",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "WA",
"license": "MD00027650",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1067594",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD",
"identifier": "LE3004",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LABOR & INDUSTRY",
"identifier": "0039581",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA/USHC PCP",
"identifier": "US0899742",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bainbridge Island, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.