Connie L Harris, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

AP61200624 Issued in WA

Practice address

840 E Hill Ave
Moses Lake, WA 98837-2238

Phone

(509) 663-8711

NPI assigned

Jan 23, 2006

Last updated

Jul 27, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2004

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Theoria MedicalGroup PAC ID 5395098339, 317 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Three Rivers Health Hospital, Three Rivers, MI, CCN 230015

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: charris83394@edirect.chehr.org
• Direct secure messaging: charris9684@direct.bronsonhg.org

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.

• Theoria Medical

  • Internal Medicine Physician
  • Novi, MI
  • NPI 1609362375
  Medicare reassignment Care Compare group NPD
• Bronson Lakeview Hospital

  dba Bronson Medical Group

  • Internal Medicine Physician
  • Paw Paw, MI
  • NPI 1235131137
  Medicare reassignment NPD
• Bronson Methodist Hospital

  • Physician Assistant
  • Kalamazoo, MI
  • NPI 1013089820
  Medicare reassignment
• Bronson Methodist Hospital

  dba Bronson Medical Group

  • Hospitalist Physician
  • Kalamazoo, MI
  • NPI 1417961137
  Medicare reassignment
• Complexcare Medical Group Midwest M PLLC

  • Internal Medicine Physician
  • Novi, MI
  • NPI 1528851607
  Medicare reassignment
• Bronson Lakeview Hospital

  dba Bronson LakeView Family Care-Blue Star

  • Rural Health Clinic/Center
  • South Haven, MI
  • NPI 1801538871
  NPD
• Beaver Island Rural Health Center

  • Rural Health Clinic/Center
  • Beaver Island, MI
  • NPI 1407828080
  NPD (past)
• Wellbridge of Clarkston, LLC

  • Skilled Nursing Facility
  • Independence Township, MI
  • NPI 1669965299
  NPD (past)

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

• Three Rivers Health System, Inc

  dba Three Rivers Health

  • General Acute Care Hospital
  • Three Rivers, MI
  • NPI 1568739423
  Care Compare affiliation

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

{
    "created_epoch": "1137974400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690416000000",
    "number": "1861462996",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "820 N CHELAN AVE",
            "city": "WENATCHEE",
            "state": "WA",
            "postal_code": "988012028",
            "telephone_number": "509-663-8711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "840 E HILL AVE",
            "city": "MOSES LAKE",
            "state": "WA",
            "postal_code": "988372238",
            "telephone_number": "509-663-8711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARRIS",
        "first_name": "CONNIE",
        "middle_name": "L",
        "name_prefix": "Mrs.",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-23",
        "last_updated": "2023-07-27",
        "certification_date": "2023-07-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WA",
            "license": "AP61200624",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1861462996",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4784689",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "50-0-87-0538-0",
            "state": "MI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicoxy.et0764.epichosted.com/FHIRProxy/api/FHIR/Rpr4/",
            "affiliation": "N",
            "address_1": "840 E Hill Ave",
            "city": "Moses Lake",
            "state": "WA",
            "country_code": "US",
            "postal_code": "988372238",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "charris83394@edirect.chehr.org",
            "affiliation": "N",
            "address_1": "840 E Hill Ave",
            "city": "Moses Lake",
            "state": "WA",
            "country_code": "US",
            "postal_code": "988372238",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Craig Ronald Harder, D.D.S.
• Matthew Hardy, M.S., D.O.
• Ryan Hardy
• Karan D Harkness, NP
• Kimberly Harley, BSW
• Tara Harris, LMP
• Richard Howell Harrison, O.D.
• Carol Hart
• Gretchen Hart
• Rebecca Hartwell

• Family Nurse Practitioner in Moses Lake, WA
• Providers in Moses Lake, WA by specialty
• Family Nurse Practitioner in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2023; 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.