Active NPI
Jan Stuart Connelly, MD
- Otolaryngology Physician
- Spokane, WA
National Provider Identifier
1972554046
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Otolaryngology Physician
- License
- MD000019284
- Practice address
- 217 W Cataldo
Spokane, WA 99201-2217 - Phone
- (509) 624-2326
- Fax
- (509) 744-3040
- NPI assigned
- May 13, 2006
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Otolaryngology Physician | 207Y00000X | MD000019284 | WA | Primary |
Addresses
Primary practice location
217 W Cataldo
Spokane, WA 99201-2217
Mailing address
217 W Cataldo
Spokane, WA 99201-2217
Phone (509) 624-2326
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 99107 | Other | WA | L & I |
| 1784701 | Medicaid | WA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD000019284 | WA | MD | Otolaryngology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147478400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1268697600000",
"number": "1972554046",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "217 W CATALDO",
"city": "SPOKANE",
"state": "WA",
"postal_code": "992012217",
"telephone_number": "509-624-2326",
"fax_number": "509-744-3040"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "217 W CATALDO",
"city": "SPOKANE",
"state": "WA",
"postal_code": "992012217",
"telephone_number": "509-624-2326",
"fax_number": "509-744-3040"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CONNELLY",
"first_name": "JAN",
"middle_name": "STUART",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-13",
"last_updated": "2010-03-16",
"status": "A"
},
"taxonomies": [
{
"code": "207Y00000X",
"taxonomy_group": "",
"desc": "Otolaryngology",
"state": "WA",
"license": "MD000019284",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "L & I",
"identifier": "99107",
"state": "WA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1784701",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Spokane, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.