Individual provider Active NPI

William Lewis Conklin, MD

  • Anesthesiology Physician
  • Olympia, WA
National Provider Identifier
1467414722
Registry record updated Mar 11, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
36242 Issued in WA
Practice address
3624 Ensign Rd NE
Ste B
Olympia, WA 98506-5074
Phone
(360) 438-6435
NPI assigned
Apr 3, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 11, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 36242 WA Primary

Addresses

Primary practice location

3624 Ensign Rd NE
Ste B
Olympia, WA 98506-5074

Mailing address

804 Scott Nixon Memorial Dr
Augusta, GA 30907-2464
Phone (360) 438-6400

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100519000365 WA Practitioner - Anesthesiology 0941102917 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Medical College of Wisconsin, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pacific Anesthesia PCGroup PAC ID 2961399290, 91 clinicians

Practice addresses (Care Compare)

1717 S J St
Tacoma, WA 98405-4933
Phone (253) 426-4101

Hospital & facility affiliations

  • Providence St Peter Hospital Hospital, Olympia, WA, CCN 500024

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
36242WAMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Pacific Anesthesia PC Anesthesiology CurrentSince Jan 1, 2021 Accepting new patients

Locations

11808 Northup Way
Ste W300
Bellevue, WA 98005
Phone (425) 284-1545

413 Lilly Rd NE
Olympia, WA 98506
Phone (360) 491-9480

1717 S J St
Tacoma, WA 98405
Phone (253) 426-4101

Organizations & group practices 1

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.

Hospital & facility affiliations 2

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": "1144022400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1394496000000",
    "number": "1467414722",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "804 SCOTT NIXON MEMORIAL DR",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309072464",
            "telephone_number": "360-438-6400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3624 ENSIGN RD NE",
            "address_2": "STE B",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985065074",
            "telephone_number": "360-438-6435"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONKLIN",
        "first_name": "WILLIAM",
        "middle_name": "LEWIS",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-03",
        "last_updated": "2014-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "WA",
            "license": "36242",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Olympia, WA

Sources for this page

Verify at the official NPI Registry.