Organization Active NPI

Jennifer Crowe Tolo, MD

  • Family Medicine Physician
  • Bellevue, WA
National Provider Identifier
1568650448
Registry record updated Jan 12, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD00034260 Issued in WA
Legal business name
JENNIFER CROWE TOLO, MD
Practice address
1603 116TH Ave NE Ste 110
Bellevue, WA 98004-3009
Phone
(425) 458-4895
Fax
(425) 458-4895
NPI assigned
Oct 4, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 12, 2011

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

Authorized official

Name
Jennifer Crowe Tolo, MDNPI 1922023209
Title
Owner
Phone
(425) 898-8517

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X MD00034260 WA Primary

Addresses

Primary practice location

1603 116TH Ave NE Ste 110
Bellevue, WA 98004-3009

Mailing address

1722 211TH Way NE
Sammamish, WA 98074-4218
Phone (425) 898-8517

Other identifiers 1

IdentifierTypeStateIssuer
1119221MedicaidWA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040407000052 WA Part B Supplier - Clinic/Group Practice 8022001890 Receives reassigned benefits from 1 practitioner
Practice locations: Bellevue, WA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
50D1020594Crowe Tolo, Jennifer, MD1603 116TH Ave NE Ste 110, Bellevue, WA 98004Certificate of waiverApr 4, 2028

National Provider Directory

National Provider Directory

Locations

1603 116th Ave NE
Ste 110
Bellevue, WA 98004
Phone (425) 458-4895

1607 116th Ave NE
#115
Bellevue, WA 98004
Phone (425) 458-4895

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1191456000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1294790400000",
    "number": "1568650448",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1722 211TH WAY NE",
            "city": "SAMMAMISH",
            "state": "WA",
            "postal_code": "980744218",
            "telephone_number": "425-898-8517",
            "fax_number": "425-458-4895"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1603 116TH AVE NE STE 110",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980043009",
            "telephone_number": "425-458-4895",
            "fax_number": "425-458-4895"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JENNIFER CROWE TOLO, MD",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-04",
        "last_updated": "2011-01-12",
        "status": "A",
        "authorized_official_last_name": "TOLO",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "CROWE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "425-898-8517",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "MD00034260",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1119221",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bellevue, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.