NPIMap

Organization Active NPI

Overlake Neurology

  • Neurology Physician
  • Bellevue, WA
National Provider Identifier
1730112285
Registry record updated Dec 3, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
602-380-699 Issued in WA
Legal business name
OVERLAKE NEUROLOGY
Practice address
1135 116TH Ave NE
Suite 200
Bellevue, WA 98004-4623
Phone
(425) 709-7055
Fax
(425) 709-7066
NPI assigned
Jul 8, 2006
Last updated
Dec 3, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 3, 2010

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

Authorized official

Name
Daniel P. Fosmire, M.D.NPI 1427073717
Title
Partner
Phone
(425) 709-7055

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X 602-380-699 WA Primary

Addresses

Primary practice location

1135 116TH Ave NE
Suite 200
Bellevue, WA 98004-4623

Mailing address

PO Box 94568
Seattle, WA 98124-6868
Phone (888) 846-5527

Other identifiers 2

IdentifierTypeStateIssuer
182686OtherWAL & I WORKERS COMP GRP #
7124977MedicaidWA

National Provider Directory

National Provider Directory

Locations

1231 116th Ave NE
Ste 203
Bellevue, WA 98004
Phone (425) 709-7055

Practitioners & affiliated clinicians

Practitioners 2

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": "1152316800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1291334400000",
    "number": "1730112285",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 94568",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981246868",
            "telephone_number": "888-846-5527",
            "fax_number": "607-324-2369"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1135 116TH AVE NE",
            "address_2": "SUITE 200",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980044623",
            "telephone_number": "425-709-7055",
            "fax_number": "425-709-7066"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OVERLAKE NEUROLOGY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-08",
        "last_updated": "2010-12-03",
        "status": "A",
        "authorized_official_last_name": "FOSMIRE",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "P.",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "425-709-7055",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "WA",
            "license": "602-380-699",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "L & I WORKERS COMP GRP #",
            "identifier": "182686",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7124977",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bellevue, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2010; 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.