NPIMap

Organization Active NPI

Bellegrove OB/GYN, Inc. PS

  • Obstetrics & Gynecology Physician
  • Bellevue, WA
National Provider Identifier
1104931039
Registry record updated May 11, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
Legal business name
BELLEGROVE OB/GYN, INC. PS
Practice address
1200 112TH Ave NE Ste C115
Bellevue, WA 98004-3745
Phone
(425) 455-0244
Fax
(425) 455-9411
NPI assigned
Aug 20, 2006
Last updated
May 11, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 11, 2017

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

Authorized official

Name
Mitchell E Nudelman, MDNPI 1801822176
Title
President
Phone
(425) 455-0244

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207V00000X Primary
Ambulatory Surgical Clinic/Center 261QA1903X 600249764 WA

Addresses

Primary practice location

1200 112TH Ave NE Ste C115
Bellevue, WA 98004-3745

Mailing address

1200 112TH Ave NE Ste C115
Bellevue, WA 98004-3745
Phone (425) 455-0244

National Provider Directory

National Provider Directory

Locations

1200 112th Ave NE
Ste C115
Bellevue, WA 98004
Phone (425) 455-0244

Practitioners & affiliated clinicians

Practitioners 18

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1156032000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1494460800000",
    "number": "1104931039",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 112TH AVE NE STE C115",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980043745",
            "telephone_number": "425-455-0244",
            "fax_number": "425-455-9411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 112TH AVE NE STE C115",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980043745",
            "telephone_number": "425-455-0244",
            "fax_number": "425-455-9411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BELLEGROVE OB/GYN, INC. PS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-20",
        "last_updated": "2017-05-11",
        "status": "A",
        "authorized_official_last_name": "NUDELMAN",
        "authorized_official_first_name": "MITCHELL",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "425-455-0244",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "WA",
            "license": "600249764",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bellevue, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.