Annie Chisholm

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

AP60583266 Issued in WA

Practice address

510 W 1St Ave
Toppenish, WA 98948-1564

Phone

(509) 865-5600

Fax

(509) 865-5783

NPI assigned

May 28, 2015

Last updated

Mar 5, 2018By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Specialty

Nurse Practitioner

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

The Wallace Medical ConcernGroup PAC ID 2365680865, shared by 2 NPIs, 10 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

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.

• The Wallace Medical Concern

  dba Wallace

  • Dentist
  • Portland, OR
  • NPI 1215390091
  NPD (past)

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

{
    "created_epoch": "1432771200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1520208000000",
    "number": "1821477365",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "510 W 1ST AVE",
            "city": "TOPPENISH",
            "state": "WA",
            "postal_code": "989481564",
            "telephone_number": "509-865-5600",
            "fax_number": "509-865-5783"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "510 W 1ST AVE",
            "city": "TOPPENISH",
            "state": "WA",
            "postal_code": "989481564",
            "telephone_number": "509-865-5600",
            "fax_number": "509-865-5783"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "418 Curie Blvd",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191044217",
            "country_code": "US",
            "telephone_number": "215-898-8281",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CHISHOLM",
        "first_name": "ANNIE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-05-28",
        "last_updated": "2018-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WA",
            "license": "RN60579730",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "NP95002294",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WA",
            "license": "AP60583266",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kathleen Casey, MSW
• Emily Castle, PHARMD
• Susie Ceja
• Samuel Remus Cerezo, RN
• Jeanine Noelette Charvet-Pederson, PHARMACIST
• Cindy R Cholico
• Michele D Cienfuegos, RN
• Petr Cigner, M.D.
• Cheyenne Don'a Clapper
• Kim Collier, RN, BSN

• Nurse Practitioner in Toppenish, WA
• Providers in Toppenish, WA by specialty
• Nurse Practitioner in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.