NPIMap

Individual provider Active NPI

Michael Mark Nelson, M.D.

  • Dermatology Physician
  • Gig Harbor, WA
National Provider Identifier
1093765034
Registry record updated Apr 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
MD60058324 Issued in WA
Practice address
4700 Point Fosdick Dr NW Ste 219
Gig Harbor, WA 98335
Phone
(253) 851-7733
Fax
(253) 851-8060
NPI assigned
May 11, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 30, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X MD60058324 WA Primary

Addresses

Primary practice location

4700 Point Fosdick Dr NW Ste 219
Gig Harbor, WA 98335

Mailing address

4700 Point Fosdick Dr NW Ste 219
Gig Harbor, WA 98335-1706
Phone (253) 851-7733

Other practice location 1

4707 S 19th St Ste 130
Tacoma, WA 98405-1151
Phone (253) 752-2273

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mnelson@directaddress.net Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090115000610 WA Practitioner - Dermatology 1850394073 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
Vanderbilt University School of Medicine, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Silver Falls Dermatology LLCGroup PAC ID 5890863492, 100 clinicians

Practice addresses (Care Compare)

19917 7TH Ave NE
Suite 101
Poulsbo, WA 98370-6555
Phone (360) 824-5474

7901 Skansie Ave
Suite 200
Gig Harbor, WA 98335-8349
Phone (253) 400-1202

Hospital & facility affiliations

  • St Joseph Medical Center Hospital, Tacoma, WA, CCN 500108

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision12
Removal of skin lesions1447
Removal or shaving of skin growth14
Skin biopsy166

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Harbor Dermatology PLLC Dermatology CurrentSince Jan 18, 2022 Accepting new patients
Mark H Tseng MD PC PastSince Jul 1, 2011 Accepting new patients
Eric O Rasmussen Dermatology Past Accepting new patients
Associates in Dermatology of Traverse City PC PastSince Aug 1, 2015 Accepting new patients
Peninsula Dermatology & Laser Clinic PLLC Dermatology Past Accepting new patients

Locations

7901 Skansie Ave
Ste 200
Gig Harbor, WA 98335
Phone (253) 400-1202

Interoperability endpoints

  • FHIR API: https://traversedermatology.mmi.prod.fhir.ema-api.com/fhir/r4/
  • FHIR API: https://app.meldrx.com/api/fhir/ez_00146

Organizations & group practices 7

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.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1147305600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1588204800000",
    "number": "1093765034",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4700 POINT FOSDICK DR NW STE 219",
            "city": "GIG HARBOR",
            "state": "WA",
            "postal_code": "983351706",
            "telephone_number": "253-851-7733",
            "fax_number": "253-851-8060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4700 POINT FOSDICK DR NW STE 219",
            "city": "GIG HARBOR",
            "state": "WA",
            "postal_code": "98335",
            "telephone_number": "253-851-7733",
            "fax_number": "253-851-8060"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4707 S 19th St Ste 130",
            "address_purpose": "LOCATION",
            "city": "Tacoma",
            "state": "WA",
            "postal_code": "984051151",
            "country_code": "US",
            "telephone_number": "253-752-2273",
            "fax_number": "253-759-0914",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NELSON",
        "first_name": "MICHAEL",
        "middle_name": "MARK",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-11",
        "last_updated": "2020-04-30",
        "certification_date": "2020-04-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "WA",
            "license": "MD60058324",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mnelson@directaddress.net",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "mnelson@directaddress.net",
            "address_1": "4700 Point Fosdick Dr NW Ste 219",
            "city": "Gig Harbor",
            "state": "WA",
            "country_code": "US",
            "postal_code": "98335",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Gig Harbor, WA

Sources for this page

Verify at the official NPI Registry.