Active NPI
Bruce Amundson, M.D.
- Family Medicine Physician
- Shoreline, WA
National Provider Identifier
1962890657
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- MD 000177751
- Practice address
- 18454 16TH Ave NW
Shoreline, WA 98177-3310 - Phone
- (206) 542-5690
- NPI assigned
- Jan 3, 2015
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | MD 000177751 | WA | Primary |
Addresses
Primary practice location
18454 16TH Ave NW
Shoreline, WA 98177-3310
Mailing address
18454 16TH Ave NW
Shoreline, WA 98177-3310
Phone (206) 542-5690
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD 000177751 | WA | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1420243200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1420243200000",
"number": "1962890657",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "18454 16TH AVE NW",
"city": "SHORELINE",
"state": "WA",
"postal_code": "981773310",
"telephone_number": "206-542-5690"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "18454 16TH AVE NW",
"city": "SHORELINE",
"state": "WA",
"postal_code": "981773310",
"telephone_number": "206-542-5690"
}
],
"practiceLocations": [],
"basic": {
"last_name": "AMUNDSON",
"first_name": "BRUCE",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-01-03",
"last_updated": "2015-01-03",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "WA",
"license": "MD 000177751",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Shoreline, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2015; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.