Individual provider Active NPI

Robert T. Truckner, M.D.

  • Pediatric Emergency Medicine (Pediatrics) Physician
  • Spokane, WA
National Provider Identifier
1912935719
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Emergency Medicine (Pediatrics) PhysicianTaxonomy code 2080P0204X
License
2005-01369 Issued in NC
Practice address
101 W 8TH Ave
Spokane, WA 99204-2307
Phone
(919) 357-7654
NPI assigned
Jun 29, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 2005-01369 NC
Pediatric Emergency Medicine (Pediatrics) Physician 2080P0204X 2005-01369 NC Primary

Addresses

Primary practice location

101 W 8TH Ave
Spokane, WA 99204-2307

Mailing address

11611 S Baltimore Rd
Spokane, WA 99223-9553
Phone (919) 357-7654

Other practice location 1

212 Ashville Ave
Suite 10
Cary, NC 27511-6669
Phone (919) 859-1136

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA, NM2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20100204000827 WA Practitioner - Pediatric MedicinePractitioner - Emergency Medicine 5395888929
I20231212003951 NM Practitioner - Emergency Medicine 5395888929 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
2005-01369NCMDPediatric Emergency Medicine (Pediatrics) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Taos Comprehensive Health Corporation CurrentSince Dec 1, 2023 Accepting new patients
Angel Fire Primary Care Past Accepting new patients

Locations

7555 Enchanted Hills Blvd NE
Ste 104
Rio Rancho, NM 87144
Phone (505) 771-9833

7555 Enchanted Hills Blvd NE
Rio Rancho, NM 87144
Phone (505) 771-9833

707 Paseo de Peralta
Santa Fe, NM 87501
Phone (505) 577-4543

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": "1151539200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1912935719",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11611 S BALTIMORE RD",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992239553",
            "telephone_number": "919-357-7654"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 W 8TH AVE",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992042307",
            "telephone_number": "919-357-7654"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "212 Ashville Ave",
            "address_2": "Suite 10",
            "address_purpose": "LOCATION",
            "city": "Cary",
            "state": "NC",
            "postal_code": "275116669",
            "country_code": "US",
            "telephone_number": "919-859-1136",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TRUCKNER",
        "first_name": "ROBERT",
        "middle_name": "T.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-29",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NC",
            "license": "2005-01369",
            "primary": false
        },
        {
            "code": "2080P0204X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Emergency Medicine",
            "state": "NC",
            "license": "2005-01369",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Spokane, WA

Sources for this page

Verify at the official NPI Registry.