NPIMap

Individual provider Active NPI

Bruce Wayne Higginbotham, MD

  • Family Medicine Physician
  • Lakewood, WA
National Provider Identifier
1679544225
Registry record updated Apr 2, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD00043885 Issued in WA
Practice address
10510 Gravelly Lake Dr SW
Community Health Care
Lakewood, WA 98499-5036
Phone
(253) 722-1837
Fax
(253) 722-1851
NPI assigned
Jan 31, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 2, 2012

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 MD00043885 WA Primary
Emergency Medicine Physician 207P00000X MD00043885 WA

Addresses

Primary practice location

10510 Gravelly Lake Dr SW
Community Health Care
Lakewood, WA 98499-5036

Mailing address

101 E 26TH Street
Tacoma, WA 98421
Phone (253) 722-1837

Other identifiers 2

IdentifierTypeStateIssuer
P00385219OtherARRAILROAD MEDICARE
164111001MedicaidAR

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

LicenseStateTypeSpecialty
20855OKMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Pacific County Hospital District 2 Family Medicine Past Accepting new patients
Plateau Emergency Physicians Emergency Medicine Past Accepting new patients
Beezley Springs Inpatient Services LLC Emergency Medicine Past Accepting new patients
Pacific County Hospital District 2 PastSince Aug 1, 2012 Accepting new patients
Discovery Coast Emergency Physicians LLC Emergency Medicine Past Accepting new patients
Clallam County Public Hospital District No 1 Past Accepting new patients

Interoperability endpoints

  • FHIR API: https://api.qualifacts.org/api/fhir/forkshospital/r4/

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1138665600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1333324800000",
    "number": "1679544225",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 E 26TH STREET",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "98421",
            "telephone_number": "253-722-1837",
            "fax_number": "253-722-1851"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10510 GRAVELLY LAKE DR SW",
            "address_2": "COMMUNITY HEALTH CARE",
            "city": "LAKEWOOD",
            "state": "WA",
            "postal_code": "984995036",
            "telephone_number": "253-722-1837",
            "fax_number": "253-722-1851"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HIGGINBOTHAM",
        "first_name": "BRUCE",
        "middle_name": "WAYNE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-31",
        "last_updated": "2012-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "MD00043885",
            "primary": true
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "WA",
            "license": "MD00043885",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00385219",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "164111001",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lakewood, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.