Individual provider Active NPI

William P Brennan, MD

  • Cardiovascular Disease Physician
  • Olympia, WA
National Provider Identifier
1487655858
Registry record updated Apr 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
MD00022987 Issued in WA
Practice address
500 Lilly Rd NE
Ste 100
Olympia, WA 98506-5195
Phone
(360) 413-8525
Fax
(360) 913-8876
NPI assigned
Aug 9, 2005
Last updated
Apr 23, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 23, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Interventional Cardiology Physician 207RI0011X 22987 WA
Cardiovascular Disease Physician 207RC0000X MD00022987 WA Primary

Addresses

Primary practice location

500 Lilly Rd NE
Ste 100
Olympia, WA 98506-5195

Mailing address

500 Lilly Rd NE
Ste 100
Olympia, WA 98506-5195
Phone (360) 413-8525

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address wbrennan101351@wm.providencedirect.org Direct

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
I20100304000147 WA Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal Medicine 1456496223 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
22987WAMDInterventional Cardiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Health & Services Washington CurrentSince Jan 1, 1994 Accepting new patients
Providence Health & Services Washington Current Accepting new patients
Cardiology Associates PLLC Cardiovascular Disease Past Accepting new patients

Locations

410 Providence Ln NE
Bldg 2
Olympia, WA 98506
Phone (360) 493-4500

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

500 Lilly Rd NE
Ste 100
Olympia, WA 98506
Phone (360) 413-8525

525 Lilly Rd NE
Olympia, WA 98506
Phone (360) 413-8550

Organizations & group practices 3

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": "1123545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1619136000000",
    "number": "1487655858",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 LILLY RD NE",
            "address_2": "STE 100",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985065195",
            "telephone_number": "360-413-8525",
            "fax_number": "360-913-8876"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 LILLY RD NE",
            "address_2": "STE 100",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985065195",
            "telephone_number": "360-413-8525",
            "fax_number": "360-913-8876"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRENNAN",
        "first_name": "WILLIAM",
        "middle_name": "P",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-09",
        "last_updated": "2021-04-23",
        "certification_date": "2021-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "WA",
            "license": "22987",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "WA",
            "license": "MD00022987",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "wbrennan101351@wm.providencedirect.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "500 Lilly Rd NE",
            "address_2": "Ste 100",
            "city": "Olympia",
            "state": "WA",
            "country_code": "US",
            "postal_code": "985065195",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Olympia, WA

Sources for this page

Verify at the official NPI Registry.