Individual provider Active NPI

Gary Michael Nissen, MD

  • Anesthesiology Physician
  • Springfield, OR
National Provider Identifier
1124550520
Registry record updated Mar 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
MD203881 Issued in OR
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

Updated by the provider on Mar 22, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
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 93 clinicians

Practice addresses (Care Compare)

3333 Riverbend Dr
Springfield, OR 97477-8800
Phone (541) 222-2300

Hospital & facility affiliations

  • Sacred Heart Medical Center - Riverbend Hospital, Springfield, OR, CCN 380102
  • McKenzie-Willamette Medical Center Hospital, Springfield, OR, CCN 380020

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD203881ORMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Northwest Anesthesia Physicians PC Anesthesiology CurrentSince Aug 16, 2021 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

  • Direct secure messaging: 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.

Hospital & facility affiliations 3

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": "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

Verify at the official NPI Registry.