Individual provider Active NPI

Richard M King, PT

  • Physical Therapist
  • Grand Coulee, WA
National Provider Identifier
1467542894
Registry record updated Jun 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT00003909 Issued in WA
Practice address
321 Burdin Blvd
Grand Coulee, WA 99133-0680
Phone
(509) 633-3260
Fax
(509) 633-3212
NPI assigned
Oct 14, 2006
Last updated
Jun 11, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT00003909 WA Primary

Addresses

Primary practice location

321 Burdin Blvd
Grand Coulee, WA 99133-0680

Mailing address

411 Fortuyn Rd
Grand Coulee, WA 99133
Phone (509) 633-3260

Other identifiers 3

IdentifierTypeStateIssuer
1044342MedicaidWA
337847OtherWAL&I
G8951875OtherWAMDCR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040527000062 WA Practitioner - Physical Therapist in Private Practice 8325959273 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
025208WAMDCardiovascular Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Douglas, Grant, Lincoln & Okanogan Counties Public Hospital District 6 Current Accepting new patients
Douglas, Grant, Lincoln & Okanogan Counties Public Hospital District 6 CurrentSince Sep 1, 2014 Accepting new patients
Douglas, Grant, Lincoln & Okanogan Counties Public Hospital District 6 CurrentSince Sep 1, 2014 Accepting new patients
Douglas, Grant, Lincoln & Okanogan Counties Public Hospital District 6 Past Accepting new patients

Locations

411 Fortuyn Rd
Grand Coulee, WA 99133
Phone (509) 633-1753

Interoperability endpoints

  • Direct secure messaging: kingr@cmccares.cernerdirect.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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160784000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560211200000",
    "number": "1467542894",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "411 FORTUYN RD",
            "city": "GRAND COULEE",
            "state": "WA",
            "postal_code": "99133",
            "telephone_number": "509-633-3260",
            "fax_number": "509-633-3212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "321 BURDIN BLVD",
            "city": "GRAND COULEE",
            "state": "WA",
            "postal_code": "991330680",
            "telephone_number": "509-633-3260",
            "fax_number": "509-633-3212"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KING",
        "first_name": "RICHARD",
        "middle_name": "M",
        "name_prefix": "Mr.",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-14",
        "last_updated": "2019-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "PT00003909",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1044342",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "L&I",
            "identifier": "337847",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MDCR",
            "identifier": "G8951875",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Coulee, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.