Robert W. Corliss, M.D.
Individual provider Active NPI Internal Medicine Physician · Sumner, WA
NPI 1407940331 · NPPES record last updated Apr 11, 2012
Key facts
- NPI
- 1407940331
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- MD00032451 (WA)
- Practice address
- 5814 Graham Ave
Suite 100
Sumner, WA 98390-2728 - Phone
- (253) 863-4474
- Fax
- (253) 863-4062
- NPI assigned
- Oct 3, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100108000116 | WA | Practitioner - Family Practice | 5092814145 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD00032451 | WA | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Multicare Health System | Current | Accepting new patients | |
| Multicare Health System | Current |
Accepting new patients | |
| Multicare Health System | Internal Medicine | Current |
Accepting new patients |
Locations
4700 Point Fosdick Dr
Ste 104
Gig Harbor, WA 98335
Phone (253) 459-7590
222 State Ave N
Kent, WA 98030
Phone (253) 372-7680
5814 Graham Ave
Ste 100
Sumner, WA 98390
Phone (253) 863-4474
311 S L St
Tacoma, WA 98405
Phone (253) 403-1444
Interoperability endpoints
- rcorlissmd4192@direct.multicare.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | MD00032451 | WA | Yes |
Addresses
Primary practice location
5814 Graham Ave
Suite 100
Sumner, WA 98390-2728
Mailing address
5814 Graham Ave
Suite 100
Sumner, WA 98390-2728
Phone (253) 863-4474
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 110202913 | Other | WA | RAILROAD MEDICARE |
| 1094093 | Medicaid | WA | |
| 101904 | Other | WA | DEPT OF LABOR AND INDUST |
Other providers in Sumner, WA
- Sean Alan Christiansen
- Christy Christian Ma, LMHC, LLC
- Richard Quint Cockrell
- Colton/Christiansen PLLC
- Ronald Frank Conti
- Cornerstone Medical Clinic
- Cranedds PLLC
- Mackenzie Cronk
- Alicia Culp
- Benigno Waldo A Dagan
All providers in Sumner, WA · Internal Medicine Physician in Washington
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 11, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.