NPIMap

Individual provider Active NPI

Maureen F Ferguson, MD

  • Family Medicine Physician
  • Seattle, WA
National Provider Identifier
1619263373
Registry record updated Feb 17, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
60471517 Issued in WA
Practice address
1401 Madison St
Suite 100
Seattle, WA 98104-1316
Phone
(206) 386-6111
Fax
(208) 386-6113
NPI assigned
Jun 21, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 17, 2016

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MR-1181 ID
Family Medicine Physician 207Q00000X M-11816 ID
Family Medicine Physician 207Q00000X 60471517 WA Primary

Addresses

Primary practice location

1401 Madison St
Suite 100
Seattle, WA 98104-1316

Mailing address

190 E Bannock St
Boise, ID 83712-6241
Phone (208) 706-8526

Other identifiers 1

IdentifierTypeStateIssuer
1619263373MedicaidID

Other names 1

  • Maureen Brenna Fitzmaurice Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20151102001584 ID Practitioner - Family Practice 7012154990 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Washington School of Medicine, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Lukes Clinic - McCall LLCGroup PAC ID 7618127994, 44 clinicians

Practice addresses (Care Compare)

211 Forest St
McCall, ID 83638-5256
Phone (208) 634-2225

Hospital & facility affiliations

  • St Lukes Home Care and Hospice Home health agency, Meridian, ID, CCN 137028
  • St Luke'S McCall Hospital, McCall, ID, CCN 131312
  • St Luke'S Regional Medical Center Hospital, Boise, ID, CCN 130006
  • St Luke'S McCall Nursing home, CCN 13Z312

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MR-1181IDMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St Lukes Clinic - McCall LLC Family Medicine CurrentSince Oct 12, 2015 Accepting new patients
St Lukes McCall, LTD Family Medicine Past Accepting new patients

Locations

1000 State St
McCall, ID 83638
Phone (208) 634-2221

200 W Forest St
McCall, ID 83638
Phone (208) 630-2470

211 W Forest St
McCall, ID 83638
Phone (208) 467-7546

Interoperability endpoints

  • Direct secure messaging: mferguson19631@direct.slhs.org

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.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1308614400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1455667200000",
    "number": "1619263373",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "190 E BANNOCK ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837126241",
            "telephone_number": "208-706-8526",
            "fax_number": "206-568-7043"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 MADISON ST",
            "address_2": "SUITE 100",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981041316",
            "telephone_number": "206-386-6111",
            "fax_number": "208-386-6113"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FERGUSON",
        "first_name": "MAUREEN",
        "middle_name": "F",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-06-21",
        "last_updated": "2016-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ID",
            "license": "MR-1181",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ID",
            "license": "M-11816",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "60471517",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1619263373",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MAUREEN",
            "last_name": "FITZMAURICE",
            "middle_name": "BRENNA",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Seattle, WA

Sources for this page

Verify at the official NPI Registry.