Active NPI
Michael Scott Myers, PA-C
- Family Medicine Physician
- Shelton, WA
National Provider Identifier
1124114814
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- PA10003073
- Practice address
- 107 N 8TH St
Shelton, WA 98584-2513 - Phone
- (360) 426-9717
- Fax
- (360) 426-9750
- NPI assigned
- Oct 4, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | PA10003073 | WA | Primary |
Addresses
Primary practice location
107 N 8TH St
Shelton, WA 98584-2513
Mailing address
PO Box 11009
Olympia, WA 98508-1009
Phone (360) 352-2037
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0132055 | Other | WA | L&I |
| MY0098 | Other | WA | REGENCE RIDER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA10003073 | WA | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ideas Unlimited Inc | Family Medicine | Past | Accepting new patients |
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.
-
- Family Medicine Physician
- Shelton, WA
- NPI 1306932082
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159920000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1218067200000",
"number": "1124114814",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 11009",
"city": "OLYMPIA",
"state": "WA",
"postal_code": "985081009",
"telephone_number": "360-352-2037",
"fax_number": "360-352-0637"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "107 N 8TH ST",
"city": "SHELTON",
"state": "WA",
"postal_code": "985842513",
"telephone_number": "360-426-9717",
"fax_number": "360-426-9750"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MYERS",
"first_name": "MICHAEL",
"middle_name": "SCOTT",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-04",
"last_updated": "2008-08-07",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "WA",
"license": "PA10003073",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "L&I",
"identifier": "0132055",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "REGENCE RIDER",
"identifier": "MY0098",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Shelton, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.