Individual provider Active NPI

Carolyn C Liu, MD

  • Internal Medicine Physician
  • Sammamish, WA
National Provider Identifier
1619039401
Registry record updated May 24, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD00043607 Issued in WA
Practice address
22707 SE 29TH St
Sammamish, WA 98075-9532
Phone
(425) 455-2845
Fax
(425) 861-8602
NPI assigned
Dec 15, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 24, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD00043607 WA Primary

Addresses

Primary practice location

22707 SE 29TH St
Sammamish, WA 98075-9532

Mailing address

PO Box 84026
Seattle, WA 98124-8426
Phone (425) 401-1365

Other practice location 1

12917 SE 38th St Ste 100
Bellevue, WA 98006-1349
Phone (425) 641-4000

Other identifiers 2

IdentifierTypeStateIssuer
0192098OtherWALABOR AND INDUSTRIES
8412967MedicaidWA

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address cliu1042328@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
I20050106000920 WA Practitioner - Internal Medicine 5698723559 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Swedish Health ServicesGroup PAC ID 9537072814, 384 clinicians

Practice addresses (Care Compare)

22707 SE 29TH St
Sammamish, WA 98075-9532
Phone (425) 455-2845

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD00043607WAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Swedish Health Services Internal Medicine CurrentSince Oct 18, 2004 Accepting new patients
Swedish Health Services CurrentSince Oct 18, 2004 Accepting new patients

Locations

12917 SE 38th St
Ste 100
Bellevue, WA 98006
Phone (206) 292-7990

13020 Meridian Ave S
Everett, WA 98208
Phone (425) 357-3700

22707 SE 29th St
Sammamish, WA 98075
Phone (425) 455-2845

2450 33rd Ave W
Ste 100
Seattle, WA 98199
Phone (206) 320-3364

800 5th Ave
Ste 600
Seattle, WA 98104

Organizations & group practices 2

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": "1166140800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621814400000",
    "number": "1619039401",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 84026",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981248426",
            "telephone_number": "425-401-1365"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22707 SE 29TH ST",
            "city": "SAMMAMISH",
            "state": "WA",
            "postal_code": "980759532",
            "telephone_number": "425-455-2845",
            "fax_number": "425-861-8602"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12917 SE 38th St Ste 100",
            "address_purpose": "LOCATION",
            "city": "Bellevue",
            "state": "WA",
            "postal_code": "980061349",
            "country_code": "US",
            "telephone_number": "425-641-4000",
            "fax_number": "206-320-5845",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LIU",
        "first_name": "CAROLYN",
        "middle_name": "C",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-15",
        "last_updated": "2021-05-24",
        "certification_date": "2021-05-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WA",
            "license": "MD00043607",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LABOR AND INDUSTRIES",
            "identifier": "0192098",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8412967",
            "state": "WA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cliu1042328@wm.providencedirect.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "12917 SE 38th St Ste 100",
            "city": "Bellevue",
            "state": "WA",
            "country_code": "US",
            "postal_code": "980061349",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Sammamish, WA

Sources for this page

Verify at the official NPI Registry.