NPIMap

Individual provider Active NPI

H Gary Corless, DPM

  • Podiatrist
  • Edmonds, WA
National Provider Identifier
1609954015
Registry record updated Jan 10, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
PO00000139 Issued in WA
Practice address
7315 212TH St SW
#103
Edmonds, WA 98026
Phone
(425) 775-6996
Fax
(425) 670-8905
NPI assigned
Nov 2, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 10, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Podiatrist 213E00000X PO00000139 WA Primary

Addresses

Primary practice location

7315 212TH St SW
#103
Edmonds, WA 98026

Mailing address

PO Box 11009
Olympia, WA 98508-1009
Phone (425) 775-6996

Other identifiers 4

IdentifierTypeStateIssuer
9050600OtherWAMEDICAID/DMERC
1183409MedicaidWA
0164994OtherL AND I
5182COOtherWAREGENCE RIDER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
PO00000139WAMDPodiatrist

Practice roles

OrganizationSpecialtyStatusNew patients
Stevens Foot & Ankle LLP Podiatrist PastSince May 1, 1999 Accepting new patients
Steven H. Le Baron, DPM, Inc., PS Past Accepting new patients
Erik C Lilja DPM PLLC Podiatrist Past Accepting new patients

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1162425600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1199923200000",
    "number": "1609954015",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 11009",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985081009",
            "telephone_number": "425-775-6996",
            "fax_number": "425-670-8905"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7315 212TH ST SW",
            "address_2": "#103",
            "city": "EDMONDS",
            "state": "WA",
            "postal_code": "98026",
            "telephone_number": "425-775-6996",
            "fax_number": "425-670-8905"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CORLESS",
        "first_name": "H",
        "middle_name": "GARY",
        "credential": "DPM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-02",
        "last_updated": "2008-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "WA",
            "license": "PO00000139",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID/DMERC",
            "identifier": "9050600",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1183409",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "L AND I",
            "identifier": "0164994",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE RIDER",
            "identifier": "5182CO",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Edmonds, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.