Active NPI
Gary Michael Nissen, MD
- Anesthesiology Physician
- Springfield, OR
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anesthesiology Physician
- License
- MD203881
- Practice address
- 3333 Riverbend Dr
Springfield, OR 97477-8800 - Phone
- (541) 681-5124
- NPI assigned
- Apr 3, 2017
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anesthesiology Physician | 207L00000X | MD203881 | OR | Primary |
| Student in an Organized Health Care Education/Training Program | 390200000X |
Addresses
Primary practice location
3333 Riverbend Dr
Springfield, OR 97477-8800
Mailing address
PO Box 7247
Springfield, OR 97475-0011
Phone (541) 513-7080
Other practice location 1
925 Seneca St
Seattle, WA 98101
Phone (206) 583-6079
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OR
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210721000336 | OR | Practitioner - Anesthesiology | 5698022051 | Reassigns benefits to 1 organization |
Care Compare profile
Medicare Care Compare- Specialty
- Anesthesiology
- Education
- Creighton University School of Medicine, 2017
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Northwest Anesthesia Physicians PC
Practice addresses (Care Compare)
3333 Riverbend Dr
Springfield, OR 97477-8800
Phone (541) 222-2300
Hospital & facility affiliations
- Sacred Heart Medical Center - Riverbend
- McKenzie-Willamette Medical Center
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD203881 | OR | MD | Anesthesiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Northwest Anesthesia Physicians PC | Anesthesiology | Current | Accepting new patients |
Locations
1460 G St
Springfield, OR 97477
Phone (541) 431-0665
3333 Riverbend Dr
Springfield, OR 97477
Phone (541) 222-3154
Interoperability endpoints
- gnissen@yourcarecommunity.org
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.
-
- Anesthesiology Physician
- Springfield, OR
- NPI 1770531196
Anesthesiology, OR
Hospital & facility affiliations 3
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Springfield, OR
- NPI 1568413573
Hospital
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1491177600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1647907200000",
"number": "1124550520",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 7247",
"city": "SPRINGFIELD",
"state": "OR",
"postal_code": "974750011",
"telephone_number": "541-513-7080"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3333 RIVERBEND DR",
"city": "SPRINGFIELD",
"state": "OR",
"postal_code": "974778800",
"telephone_number": "541-681-5124"
}
],
"practiceLocations": [
{
"address_1": "925 Seneca St",
"address_purpose": "LOCATION",
"city": "Seattle",
"state": "WA",
"postal_code": "98101",
"country_code": "US",
"telephone_number": "206-583-6079",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "NISSEN",
"first_name": "GARY",
"middle_name": "MICHAEL",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-04-03",
"last_updated": "2022-03-22",
"certification_date": "2022-03-22",
"status": "A"
},
"taxonomies": [
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "OR",
"license": "MD203881",
"primary": true
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Springfield, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.