Active NPI
Connie A Innis, MD
- Diagnostic Radiology Physician
- Redmond, WA
National Provider Identifier
1649487836
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Diagnostic Radiology Physician
- License
- MD00033090
- Practice address
- 2700 152ND Ave NE
Redmond, WA 98052-5543 - Phone
- (425) 883-5151
- NPI assigned
- May 17, 2007
- 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 |
|---|---|---|---|---|
| Diagnostic Radiology Physician | 2085R0202X | MD00033090 | WA | Primary |
Addresses
Primary practice location
2700 152ND Ave NE
Redmond, WA 98052-5543
Mailing address
PO Box 34581
Seattle, WA 98124-1581
Phone (509) 241-7349
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8249864 | Medicaid | WA |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179360000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1248912000000",
"number": "1649487836",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 34581",
"city": "SEATTLE",
"state": "WA",
"postal_code": "981241581",
"telephone_number": "509-241-7349",
"fax_number": "509-241-7628"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2700 152ND AVE NE",
"city": "REDMOND",
"state": "WA",
"postal_code": "980525543",
"telephone_number": "425-883-5151"
}
],
"practiceLocations": [],
"basic": {
"last_name": "INNIS",
"first_name": "CONNIE",
"middle_name": "A",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-05-17",
"last_updated": "2009-07-30",
"status": "A"
},
"taxonomies": [
{
"code": "2085R0202X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Radiology",
"state": "WA",
"license": "MD00033090",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8249864",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Redmond, WA
- Inbalance Spinal Health & Wellness Center PLLC (Redmond Spinal Care)
- Daphna Inbar Rosman
- Ines Taylor Brown, PLLC
- Infinity Sports Rehab
- Infintiy Rehab
- Innova Physical Therapy LLC
- Integrated Health PLLC (Integrated Health Center)
- Integrated Rehabilitation Group Inc (Redmond Ridge Physical & Hand Therapy)
- Interlake Medical Center, PLLC
- Invenia Therapeutic & Consultation Services, LLC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.