Active NPI
Susan E Thompson, M.D.
- Internal Medicine Physician
- Walla Walla, WA
National Provider Identifier
1841264611
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- MD00024761
- Practice address
- 55 W Tietan St
Walla Walla, WA 99362-4445 - Phone
- (509) 525-3720
- Fax
- (509) 522-1588
- NPI assigned
- Feb 16, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | MD00024761 | WA | Primary |
Addresses
Primary practice location
55 W Tietan St
Walla Walla, WA 99362-4445
Mailing address
55 W Tietan St
Walla Walla, WA 99362-4445
Phone (509) 525-3720
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1029388 | Medicaid | WA | |
| 155341 | Medicaid | OR | |
| 110055232 | Other | WA | RAIL ROAD MEDICARE |
| 30245 | Other | WA | L&I |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walla Walla Clinic, Inc. | Past | Accepting new patients |
Interoperability endpoints
- https://api.platform.athenahealth.com/28594/brand/1/csg/1/fhir/r4
Organizations & group practices 1
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.
-
- Clinic/Center
- Milton Freewater, OR
- NPI 1063521862
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1140048000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1397088000000",
"number": "1841264611",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "55 W TIETAN ST",
"city": "WALLA WALLA",
"state": "WA",
"postal_code": "993624445",
"telephone_number": "509-525-3720",
"fax_number": "509-522-1592"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "55 W TIETAN ST",
"city": "WALLA WALLA",
"state": "WA",
"postal_code": "993624445",
"telephone_number": "509-525-3720",
"fax_number": "509-522-1588"
}
],
"practiceLocations": [],
"basic": {
"last_name": "THOMPSON",
"first_name": "SUSAN",
"middle_name": "E",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-02-16",
"last_updated": "2014-04-10",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "WA",
"license": "MD00024761",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1029388",
"state": "WA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "155341",
"state": "OR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAIL ROAD MEDICARE",
"identifier": "110055232",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "L&I",
"identifier": "30245",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Walla Walla, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.