Active NPI
Kathleen Ann McCormick, MD
- Family Medicine Physician
- Battle Ground, WA
National Provider Identifier
1427013275
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- MD60125725
- Practice address
- 101 NW 12TH Ave
Suite 107
Battle Ground, WA 98604-9141 - Phone
- (360) 687-6650
- NPI assigned
- Apr 17, 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 15379 | AZ | |
| Family Medicine Physician | 207Q00000X | MD60125725 | WA | Primary |
Addresses
Primary practice location
101 NW 12TH Ave
Suite 107
Battle Ground, WA 98604-9141
Mailing address
PO Box 3158
Portland, OR 97208-3158
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 500635744 | Medicaid | OR | |
| 265761 | Medicaid | AZ | |
| P01039121 | Other | WA | RR MEDICARE - PH&S |
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
| License | State | Type | Specialty |
|---|---|---|---|
| 15379 | AZ | MD | Pharmacist |
| MD60125725 | WA | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Center for Physical Medicine & Rehabilitation P C | Past | Accepting new patients | |
| Med 97 LLC | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Physical Medicine & Rehabilitation Physician
- Phoenix, AZ
- NPI 1306959218
-
- Urgent Care Clinic/Center
- Phoenix, AZ
- NPI 1487631883
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1145232000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1360281600000",
"number": "1427013275",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 3158",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972083158"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "101 NW 12TH AVE",
"address_2": "SUITE 107",
"city": "BATTLE GROUND",
"state": "WA",
"postal_code": "986049141",
"telephone_number": "360-687-6650"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCCORMICK",
"first_name": "KATHLEEN",
"middle_name": "ANN",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-04-17",
"last_updated": "2013-02-08",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "AZ",
"license": "15379",
"primary": false
},
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "WA",
"license": "MD60125725",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "500635744",
"state": "OR"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "265761",
"state": "AZ"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE - PH&S",
"identifier": "P01039121",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Battle Ground, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.