NPIMap

Individual provider Active NPI

Todd J Carlson, M.D.

  • Family Medicine Physician
  • Port Townsend, WA
National Provider Identifier
1164475554
Registry record updated Sep 1, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD00038106 Issued in WA
Practice address
915 Sheridan St
Suite B103
Port Townsend, WA 98368-2931
Phone
(360) 379-8031
Fax
(360) 385-0418
NPI assigned
May 18, 2006
Sex
Male
Sole proprietor
No

Organizations & group practices 10

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 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Minnesota Medical School, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Jefferson County Public Hospital District No 2 151 clinicians

Practice addresses (Care Compare)

1010 Sheridan St
Suite 101
Port Townsend, WA 98368-2901
Phone (360) 385-3500

915 Sheridan St
Port Townsend, WA 98368-2931
Phone (360) 379-8031

934 Sheridan St
Port Townsend, WA 98368-2957
Phone (360) 385-5338

Hospital & facility affiliations

  • Jefferson Healthcare Home Health Home health agency, Port Townsend, WA, CCN 507050
  • Jefferson Healthcare Home Health Hospice, PT Townsend, WA, CCN 501538
  • Jefferson Healthcare Hospital, Port Townsend, WA, CCN 501323
  • Olympic Medical Center Hospital, Port Angeles, WA, CCN 500072
  • St Michael Medical Center Hospital, Silverdale, WA, CCN 500039

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110214000392 WA Practitioner - Family Practice 6800076514 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD00038106WAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Jefferson County Public Hospital District No 2 CurrentSince Dec 23, 2010 Accepting new patients
Jefferson County Public Hospital District No 2 CurrentSince Dec 23, 2010 Accepting new patients

Locations

834 Sheridan St
Port Townsend, WA 98368
Phone (360) 344-0400

1200 W Sims Way
Ste C
Port Townsend, WA 98368
Phone (360) 385-6297

915 Sheridan St
Port Townsend, WA 98368
Phone (360) 379-8031

934 Sheridan St
Port Townsend, WA 98368
Phone (360) 385-5330

915 Sheridan St
Ste B103
Port Townsend, WA 98368
Phone (360) 379-8031

1010 Sheridan St
Ste 101
Port Townsend, WA 98368
Phone (360) 379-8031

Interoperability endpoints

  • Direct secure messaging: tcarlson295048@wm.providencedirect.org

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MD00038106 WA Primary

Addresses

NPPES NPI Registry

Primary practice location

915 Sheridan St
Suite B103
Port Townsend, WA 98368-2931

Mailing address

915 Sheridan St
Suite B103
Port Townsend, WA 98368-2931
Phone (360) 379-8031

Other identifiers 2

NPPES NPI Registry
IdentifierTypeStateIssuer
1109834MedicaidWA
AB37466OtherWAMEDICARE RHC

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Sep 1, 2011.

{
    "created_epoch": "1147910400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1314835200000",
    "number": "1164475554",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "915 SHERIDAN ST",
            "address_2": "SUITE B103",
            "city": "PORT TOWNSEND",
            "state": "WA",
            "postal_code": "983682931",
            "telephone_number": "360-379-8031",
            "fax_number": "360-385-0418"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "915 SHERIDAN ST",
            "address_2": "SUITE B103",
            "city": "PORT TOWNSEND",
            "state": "WA",
            "postal_code": "983682931",
            "telephone_number": "360-379-8031",
            "fax_number": "360-385-0418"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARLSON",
        "first_name": "TODD",
        "middle_name": "J",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-18",
        "last_updated": "2011-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "MD00038106",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1109834",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RHC",
            "identifier": "AB37466",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Townsend, WA

Sources for this page

Verify at the official NPI Registry.