Individual provider Active NPI

Charis Marie McCoy, APRN FNP-BC

  • Family Nurse Practitioner
  • Bonney Lake, WA
National Provider Identifier
1518317072
Registry record updated Mar 16, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
77276 Issued in KS
Practice address
10004 204TH Ave E
Bonney Lake, WA 98391-6539
Phone
(253) 848-5951
Fax
(253) 845-7073
NPI assigned
Jun 15, 2016
Last updated
Mar 16, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 16, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 77276 KS Primary

Addresses

Primary practice location

10004 204TH Ave E
Bonney Lake, WA 98391-6539

Mailing address

1122 N Topeka St
Wichita, KS 67214-2810
Phone (316) 866-2000

Other names 1

  • Miss Charis Jones Former name

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210405000861 WA Practitioner - Nurse Practitioner 8325330962 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
South Hill Family Medicine PCGroup PAC ID 8729980396, 67 clinicians

Practice addresses (Care Compare)

10004 204TH Ave E
Suite 3400
Bonney Lake, WA 98391-6536
Phone (253) 848-5951

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
77276KSMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
South Hill Family Medicine PC CurrentSince Apr 1, 2021 Accepting new patients

Locations

10004 204th Ave E
Ste 3400
Bonney Lake, WA 98391
Phone (253) 841-9640

3908 10th St SE
Puyallup, WA 98374
Phone (253) 848-5951

611 31st Ave SW
Ste C
Puyallup, WA 98373
Phone (253) 848-5951

Interoperability endpoints

  • Direct secure messaging: cmccoy35088@direct.tecmc.com

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, 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": "1465948800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615852800000",
    "number": "1518317072",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1122 N TOPEKA ST",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672142810",
            "telephone_number": "316-866-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10004 204TH AVE E",
            "city": "BONNEY LAKE",
            "state": "WA",
            "postal_code": "983916539",
            "telephone_number": "253-848-5951",
            "fax_number": "253-845-7073"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCOY",
        "first_name": "CHARIS",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "APRN FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-06-15",
        "last_updated": "2021-03-16",
        "certification_date": "2021-03-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "KS",
            "license": "77276",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CHARIS",
            "last_name": "JONES",
            "prefix": "MISS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Bonney Lake, WA

Sources for this page

Verify at the official NPI Registry.