NPIMap

Organization Active NPI

Tumwater Family Practice Clinic

  • Family Medicine Physician
  • Tumwater, WA
National Provider Identifier
1881638559
Registry record updated Dec 18, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
TUMWATER FAMILY PRACTICE CLINIC
Practice address
150 Dennis St SW
Tumwater, WA 98501-5459
Phone
(360) 754-3637
Fax
(360) 754-6429
NPI assigned
Jun 15, 2006
Last updated
Dec 18, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 18, 2009

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

Authorized official

Name
Jennifer L Tyler
Title
Clinc Administrator
Phone
(360) 754-6367

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X Primary

Addresses

Primary practice location

150 Dennis St SW
Tumwater, WA 98501-5459

Mailing address

150 Dennis St SW
Tumwater, WA 98501-5459
Phone (360) 754-3637

Other identifiers 2

IdentifierTypeStateIssuer
7022346MedicaidWA
77100OtherWALABOR & INDUSTRIES

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040311000816 WA Part B Supplier - Clinic/Group Practice 4587553268 Receives reassigned benefits from 17 practitioners
Practice locations: Tumwater, WA

National Provider Directory

National Provider Directory

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/FDHGAA

Practitioners & affiliated clinicians

Practitioners 18

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1150329600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1261094400000",
    "number": "1881638559",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 DENNIS ST SW",
            "city": "TUMWATER",
            "state": "WA",
            "postal_code": "985015459",
            "telephone_number": "360-754-3637",
            "fax_number": "360-754-6429"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 DENNIS ST SW",
            "city": "TUMWATER",
            "state": "WA",
            "postal_code": "985015459",
            "telephone_number": "360-754-3637",
            "fax_number": "360-754-6429"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TUMWATER FAMILY PRACTICE CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-15",
        "last_updated": "2009-12-18",
        "status": "A",
        "authorized_official_last_name": "TYLER",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CLINC ADMINISTRATOR",
        "authorized_official_telephone_number": "360-754-6367"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7022346",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LABOR & INDUSTRIES",
            "identifier": "77100",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tumwater, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.