Individual provider Active NPI

Michael R Nelsen, M.D.

  • Diagnostic Radiology Physician
  • Federal Way, WA
National Provider Identifier
1124028568
Registry record updated Jan 27, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
MD00036302 Issued in WA
Practice address
533 S 336TH St
Suite C
Federal Way, WA 98003-6329
Phone
(253) 661-1700
Fax
(253) 661-4565
NPI assigned
Jul 28, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 27, 2012

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X MD00036302 WA Primary
Vascular & Interventional Radiology Physician 2085R0204X MD00036302 WA

Addresses

Primary practice location

533 S 336TH St
Suite C
Federal Way, WA 98003-6329

Mailing address

PO Box 26730
Federal Way, WA 98093-3730
Phone (253) 661-1700

Other identifiers 1

IdentifierTypeStateIssuer
8271041MedicaidWA

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
I20050720000433 WA Practitioner - Diagnostic RadiologyPractitioner - Interventional Radiology 5395772453 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic RadiologyAlso: Interventional Radiology
Education
University of Washington School of Medicine, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

2311 N 64TH St
Seattle, WA 98103-5403
Phone (253) 661-1700

400 S 43Rd St
Valley Medical Center
Renton, WA 98055-5714
Phone (425) 656-5550

4667 172ND PL SE
Bellevue, WA 98006-6541
Phone (253) 661-1700

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Vantage Radiology & Diagnostic Services, a Professional Services Corp Diagnostic Radiology CurrentSince Jul 23, 2001 Accepting new patients

Locations

533 S 336th St
Ste C
Federal Way, WA 98003
Phone (253) 661-4755

400 S 43rd St
Renton, WA 98055
Phone (425) 228-3450

Organizations & group practices 1

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 5

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": "1122508800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1327622400000",
    "number": "1124028568",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 26730",
            "city": "FEDERAL WAY",
            "state": "WA",
            "postal_code": "980933730",
            "telephone_number": "253-661-1700",
            "fax_number": "253-661-4565"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "533 S 336TH ST",
            "address_2": "SUITE C",
            "city": "FEDERAL WAY",
            "state": "WA",
            "postal_code": "980036329",
            "telephone_number": "253-661-1700",
            "fax_number": "253-661-4565"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NELSEN",
        "first_name": "MICHAEL",
        "middle_name": "R",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-28",
        "last_updated": "2012-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "WA",
            "license": "MD00036302",
            "primary": true
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "WA",
            "license": "MD00036302",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8271041",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Federal Way, WA

Sources for this page

Verify at the official NPI Registry.