NPIMap

Organization Active NPI

Queen Anne Family Medicine Inc PS

  • Family Medicine Physician
  • Seattle, WA
National Provider Identifier
1679663967
Registry record updated Jun 21, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
QUEEN ANNE FAMILY MEDICINE INC PS
Practice address
1915 Queen Anne Ave N
Seattle, WA 98109-2549
Phone
(206) 284-6132
Fax
(206) 284-2566
NPI assigned
Oct 15, 2006
Last updated
Jun 21, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 21, 2018

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

Authorized official

Name
Dr. Bruce Gardner, MDNPI 1194815480
Title
Owner
Phone
(206) 284-6132

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

1915 Queen Anne Ave N
Seattle, WA 98109-2549

Mailing address

1915 Queen Anne Ave N
Seattle, WA 98109-2549
Phone (206) 284-6132

Other identifiers 1

IdentifierTypeStateIssuer
7108426MedicaidWA

National Provider Directory

National Provider Directory

Locations

1915 Queen Anne Ave N
Seattle, WA 98109
Phone (206) 284-6132

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1160870400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529539200000",
    "number": "1679663967",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1915 QUEEN ANNE AVE N",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981092549",
            "telephone_number": "206-284-6132",
            "fax_number": "206-284-2566"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1915 QUEEN ANNE AVE N",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981092549",
            "telephone_number": "206-284-6132",
            "fax_number": "206-284-2566"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "QUEEN ANNE FAMILY MEDICINE INC PS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-15",
        "last_updated": "2018-06-21",
        "status": "A",
        "authorized_official_last_name": "GARDNER",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "206-284-6132",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7108426",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "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 Jun 21, 2018; 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.