NPIMap

Individual provider Active NPI

Su Lei Tin, MD

  • Internal Medicine Physician
  • Federal Way, WA
National Provider Identifier
1639690563
Registry record updated Sep 23, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD61091055 Issued in WA
Practice address
34503 9TH Ave S
Federal Way, WA 98003-8727
Phone
(253) 835-8700
Fax
(253) 835-8000
NPI assigned
Jun 30, 2017
Last updated
Sep 23, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2020

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 MD61091055 WA Primary

Addresses

Primary practice location

34503 9TH Ave S
Federal Way, WA 98003-8727

Mailing address

34503 9TH Ave S Ste 100
Federal Way, WA 98003-8726
Phone (253) 835-8700

Other practice location 1

506 Lenox Ave
New York, NY 10037-1802
Phone (212) 939-2291

Other identifiers 1

IdentifierTypeStateIssuer
2161950MedicaidWA

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address stin634883@fhsce.catholichealth.net Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
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
I20201001000646 WA Practitioner - Internal Medicine 7416376017 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Select Outpatient Services IncGroup PAC ID 4082868815, 750 clinicians
Select Rehabilitation, LLCGroup PAC ID 9032020490, 1,935 clinicians
Franciscan Medical GroupGroup PAC ID 0547173866, 1,400 clinicians

Practice addresses (Care Compare)

2600 Compass Rd
Glenview, IL 60026-8001

34503 9TH Ave S
Suite 100
Federal Way, WA 98003-8726
Phone (253) 874-2227

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Franciscan Medical Group Current Accepting new patients
Franciscan Medical Group Internal Medicine CurrentSince Sep 21, 2020 Accepting new patients
Franciscan Medical Group Past Accepting new patients

Locations

34503 9th Ave S
Ste 100
Federal Way, WA 98003
Phone (253) 835-8700

34503 9th Ave S
Ste 130
Federal Way, WA 98003
Phone (253) 835-5340

1812 S J St
Ste 120
Tacoma, WA 98405
Phone (253) 428-2200

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 8

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": "1498780800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600819200000",
    "number": "1639690563",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "34503 9TH AVE S STE 100",
            "city": "FEDERAL WAY",
            "state": "WA",
            "postal_code": "980038726",
            "telephone_number": "253-835-8700",
            "fax_number": "253-835-8000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "34503 9TH AVE S",
            "city": "FEDERAL WAY",
            "state": "WA",
            "postal_code": "980038727",
            "telephone_number": "253-835-8700",
            "fax_number": "253-835-8000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "506 Lenox Ave",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "100371802",
            "country_code": "US",
            "telephone_number": "212-939-2291",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TIN",
        "first_name": "SU",
        "middle_name": "LEI",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-06-30",
        "last_updated": "2020-09-23",
        "certification_date": "2020-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WA",
            "license": "MD61091055",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2161950",
            "state": "WA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "stin634883@fhsce.catholichealth.net",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "34503 9th Ave S",
            "city": "Federal Way",
            "state": "WA",
            "country_code": "US",
            "postal_code": "980038727",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Federal Way, WA

Sources for this page

Verify at the official NPI Registry.