Individual provider Active NPI

William P. Momyer, D.C.

  • Chiropractor
  • Kent, WA
National Provider Identifier
1801952445
Registry record updated Jul 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
CH00001316 Issued in WA
Practice address
24612 104TH Ave SE
Kent, WA 98030-4965
Phone
(253) 859-2373
Fax
(253) 856-8754
NPI assigned
Dec 28, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 9, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X CH00001316 WA Primary

Addresses

Primary practice location

24612 104TH Ave SE
Kent, WA 98030-4965

Mailing address

24612 104TH Ave SE
Kent, WA 98030-4965
Phone (253) 859-2373

Other identifiers 2

IdentifierTypeStateIssuer
990251585 9824KEOtherWAREGENCE BLUE SHIELD
0034012OtherWADEPT L&I NUMBER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090526000359 WA Practitioner - Chiropractic 1557410453 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Sherman College of Straight Chiropractic, 1977
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

24604 104TH Ave SE
Kent, WA 98030-5385

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
CH00001316WAMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Momyer Chiropractic and Massage, P.S. Chiropractor CurrentSince May 1, 2009 Accepting new patients
Audrey M.K. Yan Past Accepting new patients

Locations

24604 104th Ave SE
Kent, WA 98030
Phone (206) 353-8146

24604 104th Ave SE
Ste 203
Kent, WA 98030
Phone (253) 859-2373

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1167264000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1801952445",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24612 104TH AVE SE",
            "city": "KENT",
            "state": "WA",
            "postal_code": "980304965",
            "telephone_number": "253-859-2373",
            "fax_number": "253-856-8754"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24612 104TH AVE SE",
            "city": "KENT",
            "state": "WA",
            "postal_code": "980304965",
            "telephone_number": "253-859-2373",
            "fax_number": "253-856-8754"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOMYER",
        "first_name": "WILLIAM",
        "middle_name": "P.",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-28",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "WA",
            "license": "CH00001316",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE BLUE SHIELD",
            "identifier": "990251585 9824KE",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPT L&I NUMBER",
            "identifier": "0034012",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kent, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.