Active NPI
Elisha Nziengui Boussengui, MD
- Family Medicine Physician
- Seattle, WA
National Provider Identifier
1639493513
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- MD60302743
- Practice address
- 314 NE Thornton PL
Seattle, WA 98125-9000 - Phone
- (206) 520-2350
- Fax
- (206) 520-2399
- NPI assigned
- Mar 20, 2010
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | MD60302743 | WA | Primary |
Addresses
Primary practice location
314 NE Thornton PL
Seattle, WA 98125-9000
Mailing address
PO Box 50095
Seattle, WA 98145-5095
Phone (206) 543-6420
Other practice location 1
5350 Tallman Ave NW Ste 301
Seattle, WA 98107-5902
Phone (206) 320-3335
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639493513 | Medicaid | WA |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | enzienguiboussengui1042738@wm.providencedirect.org | Direct |
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD60302743 | WA | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1269043200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1602115200000",
"number": "1639493513",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 50095",
"city": "SEATTLE",
"state": "WA",
"postal_code": "981455095",
"telephone_number": "206-543-6420"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "314 NE THORNTON PL",
"city": "SEATTLE",
"state": "WA",
"postal_code": "981259000",
"telephone_number": "206-520-2350",
"fax_number": "206-520-2399"
}
],
"practiceLocations": [
{
"address_1": "5350 Tallman Ave NW Ste 301",
"address_purpose": "LOCATION",
"city": "Seattle",
"state": "WA",
"postal_code": "981075902",
"country_code": "US",
"telephone_number": "206-320-3335",
"fax_number": "206-320-8027",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "NZIENGUI BOUSSENGUI",
"first_name": "ELISHA",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-03-20",
"last_updated": "2020-10-08",
"certification_date": "2020-10-08",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "WA",
"license": "MD60302743",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1639493513",
"state": "WA"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "enzienguiboussengui1042738@wm.providencedirect.org",
"affiliation": "N",
"use": "DIRECT",
"useDescription": "Direct",
"address_1": "5350 Tallman Ave NW Ste 301",
"city": "Seattle",
"state": "WA",
"country_code": "US",
"postal_code": "981075902",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Seattle, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.