Individual provider Active NPI

David W Carlson, D.O.

  • Pediatrics Physician
  • Yakima, WA
National Provider Identifier
1114185493
Registry record updated May 28, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
OP60093316 Issued in WA
Practice address
314 S 11TH Ave
Suite a
Yakima, WA 98902-3212
Phone
(509) 575-0114
Fax
(509) 575-0808
NPI assigned
May 23, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 28, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X OT-011450 PA
Pediatrics Physician 208000000X OP60093316 WA Primary

Addresses

Primary practice location

314 S 11TH Ave
Suite a
Yakima, WA 98902-3212

Mailing address

501 S 5TH Ave
Yakima, WA 98902-3550
Phone (509) 494-6700

Other identifiers 2

IdentifierTypeStateIssuer
0252037OtherWALABOR & INDUSTRIES
8543795MedicaidWA

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090825000506 WA Practitioner - Pediatric Medicine 1153496427 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
OT-011450PAMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Community Health of Central Washington CurrentSince Oct 1, 2012 Accepting new patients
Community Health of Central Washington CurrentSince Oct 1, 2012 Accepting new patients
Geisinger Clinic Past Accepting new patients
Community Health of Central Washington Pediatrics Past Accepting new patients

Locations

521 E Mountain View Ave
Ellensburg, WA 98926
Phone (509) 962-1414

501 S 5th Ave
Yakima, WA 98902
Phone (509) 494-6700

1806 W Lincoln Ave
Yakima, WA 98902
Phone (509) 452-4520

402 S 12th Ave
Yakima, WA 98902
Phone (509) 248-3263

314 S 11th Ave
Ste A
Yakima, WA 98902
Phone (509) 575-0114

Interoperability endpoints

  • Direct secure messaging: dcarlson605982@direct.ochin.org

Organizations & group practices 4

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": "1211500800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1432771200000",
    "number": "1114185493",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 S 5TH AVE",
            "city": "YAKIMA",
            "state": "WA",
            "postal_code": "989023550",
            "telephone_number": "509-494-6700",
            "fax_number": "509-573-6275"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "314 S 11TH AVE",
            "address_2": "SUITE A",
            "city": "YAKIMA",
            "state": "WA",
            "postal_code": "989023212",
            "telephone_number": "509-575-0114",
            "fax_number": "509-575-0808"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARLSON",
        "first_name": "DAVID",
        "middle_name": "W",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-05-23",
        "last_updated": "2015-05-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "PA",
            "license": "OT-011450",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "WA",
            "license": "OP60093316",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LABOR & INDUSTRIES",
            "identifier": "0252037",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8543795",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Yakima, WA

Sources for this page

Verify at the official NPI Registry.