NPIMap

Organization Active NPI

Yakima Urology at Memorial TR

  • Urology Physician
  • Yakima, WA
National Provider Identifier
1942685003
Registry record updated Jun 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
Legal business name
YAKIMA UROLOGY AT MEMORIAL TR
Practice address
2500 Racquet LN
Ste 100
Yakima, WA 98902-6114
Phone
(509) 249-3913
Fax
(509) 853-1530
NPI assigned
Jul 29, 2015
Last updated
Jun 11, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
YAKIMA VALLEY MEMORIAL HOSPITAL ASSNAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 11, 2024

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

Authorized official

Name
William Glenn Robertson
Title
Ceo
Phone
(253) 403-1272

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X NU Primary

Addresses

Primary practice location

2500 Racquet LN
Ste 100
Yakima, WA 98902-6114

Mailing address

2500 Racquet LN
Suite 100
Yakima, WA 98902-6114
Phone (509) 249-3913

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20151116000354 WA Part B Supplier - Clinic/Group Practice 9133439599 Receives reassigned benefits from 9 practitioners
Practice locations: Yakima, WA

National Provider Directory

National Provider Directory
Part of
Yakima Valley Memorial Hosp

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

Interoperability endpoints

  • FHIR API: https://app.meldrx.com/api/fhir/uc05455_yakimaurologyassoc

Practitioners & affiliated clinicians

Practitioners 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1438128000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718064000000",
    "number": "1942685003",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2500 RACQUET LN",
            "address_2": "SUITE 100",
            "city": "YAKIMA",
            "state": "WA",
            "postal_code": "989026114",
            "telephone_number": "509-249-3913",
            "fax_number": "509-853-1530"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 RACQUET LN",
            "address_2": "STE 100",
            "city": "YAKIMA",
            "state": "WA",
            "postal_code": "989026114",
            "telephone_number": "509-249-3913",
            "fax_number": "509-853-1530"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "YAKIMA UROLOGY AT MEMORIAL TR",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "YAKIMA VALLEY MEMORIAL HOSPITAL ASSN",
        "enumeration_date": "2015-07-29",
        "last_updated": "2024-06-11",
        "certification_date": "2024-06-11",
        "status": "A",
        "authorized_official_last_name": "ROBERTSON",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "GLENN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "253-403-1272"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Yakima, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2024; 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.