NPIMap

Individual provider Active NPI

Chris Brussow, MD

  • Student in an Organized Health Care Education/Training Program
  • Pasco, WA
National Provider Identifier
1346726023
Registry record updated Jul 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
7425 Wrigley Dr Ste 100
Pasco, WA 99301-5292
Phone
(509) 416-8888
NPI assigned
Jul 16, 2018
Last updated
Jul 15, 2021By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 15, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X NU Primary
Family Medicine Physician 207Q00000X MD61138389 WA

Addresses

Primary practice location

7425 Wrigley Dr Ste 100
Pasco, WA 99301-5292

Mailing address

1501 Kings Highway
Family Medicine
Shreveport, LA 71130
Phone (318) 626-0014

Other practice location 1

1501 Kings Highway
Family Medicine
Shreveport, LA 71130
Phone (318) 626-0014

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210712003818 WA Practitioner - Family Practice 2163773060 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lourdes Hospital LLCGroup PAC ID 1850642562, shared by 5 NPIs, 42 clinicians

Practice addresses (Care Compare)

7425 Wrigley Dr
Suite 100
Pasco, WA 99301-5292
Phone (509) 416-8888

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD61138389WAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lourdes Hospital LLC CurrentSince Jul 7, 2021 Accepting new patients
Lourdes Hospital LLC Family Medicine CurrentSince Jul 7, 2021 Accepting new patients
Lourdes Hospital LLC Current Accepting new patients
Lourdes Hospital LLC Past Accepting new patients
Our Lady of Lourdes Health Center Family Medicine Past Accepting new patients

Locations

1200 N 14th Ave
Pasco, WA 99301
Phone (509) 547-7536

520 N 4th Ave
Pasco, WA 99301
Phone (509) 544-6140

7425 Wrigley Dr
Ste 100
Pasco, WA 99301
Phone (509) 416-8888

7425 Wrigley Dr
Ste 204
Pasco, WA 99301
Phone (509) 416-0027

Interoperability endpoints

  • Direct secure messaging: chris.brussow.1@18485.direct.athenahealth.com

Organizations & group practices 5

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 5

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": "1531699200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626307200000",
    "number": "1346726023",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1501 KINGS HIGHWAY",
            "address_2": "FAMILY MEDICINE",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "71130",
            "telephone_number": "318-626-0014"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7425 WRIGLEY DR STE 100",
            "city": "PASCO",
            "state": "WA",
            "postal_code": "993015292",
            "telephone_number": "509-416-8888"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1501 Kings Highway",
            "address_2": "Family Medicine",
            "address_purpose": "LOCATION",
            "city": "Shreveport",
            "state": "LA",
            "postal_code": "71130",
            "country_code": "US",
            "telephone_number": "318-626-0014",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BRUSSOW",
        "first_name": "CHRIS",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-07-16",
        "last_updated": "2021-07-15",
        "certification_date": "2021-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "MD61138389",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pasco, WA

Sources for this page

Verify at the official NPI Registry.