Individual provider Active NPI

Ty C Jones, MD

  • Sports Medicine (Family Medicine) Physician
  • Renton, WA
National Provider Identifier
1649419417
Registry record updated Apr 18, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X
License
MD60296622 Issued in WA
Practice address
4011 Talbot Rd S
Suite 300
Renton, WA 98055-5773
Phone
(425) 656-5060
Fax
(425) 656-5047
NPI assigned
Feb 18, 2009
Last updated
Apr 18, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 18, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MD60296622 WA
Sports Medicine (Family Medicine) Physician 207QS0010X MD60296622 WA Primary

Addresses

Primary practice location

4011 Talbot Rd S
Suite 300
Renton, WA 98055-5773

Mailing address

805 Madison St
Suite 901
Seattle, WA 98104-1172
Phone (206) 264-8100

Other practice location 1

150 Andover Park W
Tukwila, WA 98188-2801
Phone (425) 979-2663

Other practice location 2

1620 Lake Tapps Pkwy SE Ste 115
Auburn, WA 98092-8376
Phone (425) 656-5060

Other practice location 3

24060 SE Kent Kangley Rd
Maple Valley, WA 98038-6801
Phone (425) 656-5060

Other practice location 4

27005 168th Pl SE Ste 201
Covington, WA 98042-4902
Phone (253) 630-3660

Other identifiers 2

IdentifierTypeStateIssuer
2020723MedicaidWA
351942OtherWAWA L&I

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
I20130709000196 WA Practitioner - Family PracticePractitioner - Sports Medicine 1355581778 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD60296622WAMDSports Medicine (Family Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Proliance Surgeons Inc P S Current Accepting new patients
Proliance Surgeons Inc P S Family Medicine CurrentSince Aug 24, 2015 Accepting new patients
Kaiser Foundation Health Plan of Washington CurrentSince Dec 19, 2018 Accepting new patients
Kaiser Foundation Health Plan of Washington CurrentSince Dec 19, 2018 Accepting new patients
Proliance Surgeons, Inc., P.S. Sports Medicine CurrentSince Aug 24, 2015 Accepting new patients
Proliance Surgeons Inc., P.S. Family Medicine Current Accepting new patients

Locations

1620 Lake Tapps Pkwy SE
Ste 115
Auburn, WA 98092
Phone (253) 246-2860

27005 168th Pl SE
#201
Covington, WA 98042
Phone (253) 630-3660

24060 SE Kent Kangley Rd
Maple Valley, WA 98038
Phone (425) 358-7708

4011 Talbot Rd S
Ste 300
Renton, WA 98055
Phone (206) 656-5060

200 15th Ave E
Seattle, WA 98112
Phone (206) 326-4530

805 Madison St
Ste 901
Seattle, WA 98104
Phone (206) 264-8100

9800 4th Ave NE
Seattle, WA 98115
Phone (206) 302-1200

9505 S Steele St
Tacoma, WA 98444
Phone (253) 597-6800

150 Andover Park W
Tukwila, WA 98188
Phone (425) 979-2663

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1234915200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1587168000000",
    "number": "1649419417",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "805 MADISON ST",
            "address_2": "SUITE 901",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981041172",
            "telephone_number": "206-264-8100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4011 TALBOT RD S",
            "address_2": "SUITE 300",
            "city": "RENTON",
            "state": "WA",
            "postal_code": "980555773",
            "telephone_number": "425-656-5060",
            "fax_number": "425-656-5047"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "150 Andover Park W",
            "address_purpose": "LOCATION",
            "city": "Tukwila",
            "state": "WA",
            "postal_code": "981882801",
            "country_code": "US",
            "telephone_number": "425-979-2663",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1620 Lake Tapps Pkwy SE Ste 115",
            "address_purpose": "LOCATION",
            "city": "Auburn",
            "state": "WA",
            "postal_code": "980928376",
            "country_code": "US",
            "telephone_number": "425-656-5060",
            "fax_number": "425-656-5047",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "24060 SE Kent Kangley Rd",
            "address_purpose": "LOCATION",
            "city": "Maple Valley",
            "state": "WA",
            "postal_code": "980386801",
            "country_code": "US",
            "telephone_number": "425-656-5060",
            "fax_number": "425-656-5047",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "27005 168th Pl SE Ste 201",
            "address_purpose": "LOCATION",
            "city": "Covington",
            "state": "WA",
            "postal_code": "980424902",
            "country_code": "US",
            "telephone_number": "253-630-3660",
            "fax_number": "253-631-1591",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JONES",
        "first_name": "TY",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-02-18",
        "last_updated": "2020-04-18",
        "certification_date": "2020-04-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "MD60296622",
            "primary": false
        },
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "WA",
            "license": "MD60296622",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2020723",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WA L&I",
            "identifier": "351942",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Renton, WA

Sources for this page

Verify at the official NPI Registry.