Issaquah Internal Medicine Associates, PLLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

MD00032314 Issued in WA

Legal business name

ISSAQUAH INTERNAL MEDICINE ASSOCIATES, PLLC

Practice address

450 NW Gilman Blvd Ste 301a
Issaquah, WA 98027

Phone

(425) 391-0313

Fax

(425) 837-8501

NPI assigned

Jan 18, 2006

Organization subpart

No

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

Authorized official

Name

Vicki M Rouillard, M.D.

Title

MD

Phone

(425) 391-0313

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• Vicki Rouillard M.D. Doing business as

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kim Elizabeth Pruess Nevins, MD

  • Internal Medicine Physician
  • Issaquah, WA
  • NPI 1982684833
  NPD (past)
• Victoria M Rouillard, MD

  • Internal Medicine Physician
  • Issaquah, WA
  • NPI 1578543534
  NPD (past)

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

{
    "created_epoch": "1137542400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1306800000000",
    "number": "1699755652",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1225",
            "city": "ISSAQUAH",
            "state": "WA",
            "postal_code": "980270047",
            "telephone_number": "425-391-0313",
            "fax_number": "425-837-8501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "450 NW GILMAN BLVD STE 301A",
            "city": "ISSAQUAH",
            "state": "WA",
            "postal_code": "98027",
            "telephone_number": "425-391-0313",
            "fax_number": "425-837-8501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ISSAQUAH INTERNAL MEDICINE ASSOCIATES, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-18",
        "last_updated": "2011-05-31",
        "status": "A",
        "authorized_official_last_name": "ROUILLARD",
        "authorized_official_first_name": "VICKI",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "425-391-0313",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "WA",
            "license": "MD00032314",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7090491",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CN9619",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPT OF LABOR AND INDUSTR",
            "identifier": "123345",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Vicki Rouillard M.D.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Internal Medicine Physician in Issaquah, WA
• Providers in Issaquah, WA by specialty
• Internal Medicine Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2011; 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.