NPIMap

Individual provider Active NPI

Susan Ordonio Tiu, M.D.

  • Internal Medicine Physician
  • Everett, WA
National Provider Identifier
1710148994
Registry record updated Mar 15, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD60253710 Issued in WA
Practice address
4005 Hoyt Ave
Everett, WA 98201-4920
Phone
(425) 339-5468
Fax
(425) 259-1172
NPI assigned
Jun 20, 2008
Last updated
Mar 15, 2013By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 15, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD60253710 WA Primary

Addresses

Primary practice location

4005 Hoyt Ave
Everett, WA 98201-4920

Mailing address

PO Box 5127
Everett, WA 98206-5127
Phone (425) 339-5468

Other identifiers 1

IdentifierTypeStateIssuer
MD60253710OtherWALICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120312000121 WA Practitioner - Internal Medicine 3577722560 Reassigns benefits to 2 organizations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
South Sound Inpatient Physicians PLLC Internal Medicine Current Accepting new patients
South Sound Inpatient Physicians PLLC CurrentSince Feb 10, 2014 Accepting new patients
South Sound Inpatient Physicians PLLC Internal Medicine CurrentSince Feb 10, 2014 Accepting new patients
Allen Creek Healthcare, Inc. Past Accepting new patients
Marysville Operations, LLC Past Accepting new patients

Locations

5410 Maryland Way
Ste 300
Brentwood, TN 37027
Phone (615) 377-1674

16251 Sylvester Rd SW
Burien, WA 98166
Phone (206) 244-9970

407 14th Ave SE
Puyallup, WA 98372
Phone (253) 697-4000

Ownership & related parties

All facility ownership & control disclosures 4

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Bethany at Silver LakeEverett, WA, CCN 505403 Skilled nursing facility Corporate Director (7.14%) Jan 3, 2019
Bethany at PacificEverett, WA, CCN 505404 Skilled nursing facility Corporate Director (7.14%) Jan 3, 2019
Bethany Home Health LLCEverett, WA, CCN 507135 Home health agency Corporate Director (5.88%) Jan 3, 2019
Bethany Hospice LLCEverett, WA, CCN 501564 Hospice Corporate Director (7.69%) Jan 3, 2019

Owned or controlled facilities with NPI records 4

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

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": "1213920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1363305600000",
    "number": "1710148994",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5127",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982065127",
            "telephone_number": "425-339-5468",
            "fax_number": "425-259-1172"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4005 HOYT AVE",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982014920",
            "telephone_number": "425-339-5468",
            "fax_number": "425-259-1172"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TIU",
        "first_name": "SUSAN",
        "middle_name": "ORDONIO",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-06-20",
        "last_updated": "2013-03-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WA",
            "license": "MD60253710",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "MD60253710",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Everett, WA

Sources for this page

Verify at the official NPI Registry.