Active NPI
Michael A Clancy
- Family Medicine Physician
- Port Angeles, WA
National Provider Identifier
1053481432
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- OP00000985
- Practice address
- 835 Georgiana St
Port Angeles, WA 98362-3511 - Phone
- (360) 457-8534
- Fax
- (360) 457-9741
- NPI assigned
- Nov 9, 2006
- 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 | OP00000985 | WA | Primary |
Addresses
Primary practice location
835 Georgiana St
Port Angeles, WA 98362-3511
Mailing address
835 Georgiana St
Port Angeles, WA 98362-3511
Phone (360) 457-8534
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1002898 | Medicaid | WA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20070719000435 | WA | Practitioner - Family Practice | 0446351563 | Practice locations: Port Angeles, WA |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy, Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163030400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1429228800000",
"number": "1053481432",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "835 GEORGIANA ST",
"city": "PORT ANGELES",
"state": "WA",
"postal_code": "983623511",
"telephone_number": "360-457-8534",
"fax_number": "360-457-9741"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "835 GEORGIANA ST",
"city": "PORT ANGELES",
"state": "WA",
"postal_code": "983623511",
"telephone_number": "360-457-8534",
"fax_number": "360-457-9741"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLANCY",
"first_name": "MICHAEL",
"middle_name": "A",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-11-09",
"last_updated": "2015-04-17",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "WA",
"license": "OP00000985",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1002898",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Port Angeles, WA
- Clallam County Juvenile and Family Services
- Clallam County Public Hospital District 2
- Clallam County Public Hospital District 2
- Clallam County Public Hospital District 2
- Fallon Ann Clancy, PA
- Clark Chiropractic and Massage PS
- Clark Counseling LLC
- Dustin J Clark, D.C
- Elizabeth A. Clark, LSW
- Hilary Jade Clark
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 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.