NPIMap

Individual provider Active NPI

Teresa A Andersen, MD

  • Family Medicine Physician
  • Poulsbo, WA
National Provider Identifier
1790861706
Registry record updated May 23, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD00039456 Issued in WA
Practice address
22180 Olympic College Way
Suite 201
Poulsbo, WA 98370-6664
Phone
(360) 394-3500
Fax
(360) 394-3501
NPI assigned
Oct 31, 2006
Last updated
May 23, 2011By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 23, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MD00039456 WA Primary

Addresses

Primary practice location

22180 Olympic College Way
Suite 201
Poulsbo, WA 98370-6664

Mailing address

22180 Olympic College Way
Suite 201
Poulsbo, WA 98370-6664
Phone (360) 394-3500

Other identifiers 2

IdentifierTypeStateIssuer
8281024MedicaidWA
080178173OtherWARAILROAD MEDICARE

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
I20090429000168 WA Practitioner - Family Practice 1456409515 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Washington School of Medicine, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Sound Family Medicine and Urgent Care PLLCGroup PAC ID 5496803553, 5 clinicians

Practice addresses (Care Compare)

22180 Olympic College Way NW
Suite 201
Poulsbo, WA 98370-6664
Phone (360) 394-3500

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Sound Family Medicine and Urgent Care PLLC CurrentSince Mar 28, 2009 Accepting new patients
North Kitsap Family Practice and Urgent Care P.S. Family Medicine Past Accepting new patients

Locations

22180 Olympic College Way NW
Ste 201
Poulsbo, WA 98370
Phone (360) 394-3500

Interoperability endpoints

  • Direct secure messaging: teresa.andersen.1@24533.direct.athenahealth.com

Organizations & group practices 2

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.

Hospital & facility affiliations 11

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1162252800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1306108800000",
    "number": "1790861706",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22180 OLYMPIC COLLEGE WAY",
            "address_2": "SUITE 201",
            "city": "POULSBO",
            "state": "WA",
            "postal_code": "983706664",
            "telephone_number": "360-394-3500",
            "fax_number": "360-394-3501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22180 OLYMPIC COLLEGE WAY",
            "address_2": "SUITE 201",
            "city": "POULSBO",
            "state": "WA",
            "postal_code": "983706664",
            "telephone_number": "360-394-3500",
            "fax_number": "360-394-3501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSEN",
        "first_name": "TERESA",
        "middle_name": "A",
        "name_prefix": "Ms.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-31",
        "last_updated": "2011-05-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "MD00039456",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8281024",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "080178173",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Poulsbo, WA

Sources for this page

Verify at the official NPI Registry.