Individual provider Active NPI

David Lamont Nielson, DPM

  • Foot & Ankle Surgery Podiatrist
  • Roanoke, VA
National Provider Identifier
1053503961
Registry record updated Nov 17, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
License
0103300976 Issued in VA
Practice address
222 Walnut Ave SW
Roanoke, VA 24016-4723
Phone
(540) 344-3668
Fax
(540) 769-6381
NPI assigned
Aug 14, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 17, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Foot & Ankle Surgery Podiatrist 213ES0103X 0103300976 VA Primary

Addresses

Primary practice location

222 Walnut Ave SW
Roanoke, VA 24016-4723

Mailing address

222 Walnut Ave SW
Roanoke, VA 24016-4723
Phone (540) 344-3668

Other identifiers 1

IdentifierTypeStateIssuer
1053503961MedicaidVA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV, KY2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20170828001024 WV Practitioner - Podiatry 9032280664 Reassigns benefits to 2 organizations
I20220801000896 KY Practitioner - Podiatry 9032280664 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
0103300976VAMDFoot & Ankle Surgery Podiatrist

Practice roles

OrganizationSpecialtyStatusNew patients
Williamson Memorial, Inc. CurrentSince Feb 7, 2024 Accepting new patients
Williamson Health & Wellness Center Inc CurrentSince Jul 17, 2017 Accepting new patients
Williamson Health & Wellness Center Inc Current Accepting new patients
Williamson Memorial, Inc. CurrentSince Feb 7, 2024 Accepting new patients
Williamson Health & Wellness Center Inc CurrentSince Jul 17, 2017 Accepting new patients

Locations

260 Hospital Dr
South Williamson, KY 41503
Phone (606) 237-1700

184 E 2nd Ave
Ste 201
Williamson, WV 25661

859 Alderson St
Ste 1000
Williamson, WV 25661

859 Alderson St
Williamson, WV 25661
Phone (304) 235-2500

184 E 2nd Ave
Williamson, WV 25661
Phone (304) 235-1844

184 E 2nd Ave
Ste 210
Williamson, WV 25661

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/DBJECA

Organizations & group practices 5

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": "1187049600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1226880000000",
    "number": "1053503961",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "222 WALNUT AVE SW",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240164723",
            "telephone_number": "540-344-3668",
            "fax_number": "540-769-6381"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "222 WALNUT AVE SW",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240164723",
            "telephone_number": "540-344-3668",
            "fax_number": "540-769-6381"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NIELSON",
        "first_name": "DAVID",
        "middle_name": "LAMONT",
        "name_prefix": "Mr.",
        "credential": "DPM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-08-14",
        "last_updated": "2008-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "VA",
            "license": "0103300976",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1053503961",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Roanoke, VA

Sources for this page

Verify at the official NPI Registry.