NPIMap

Individual provider Active NPI

Daiva Nevidomskyte, MD

  • Vascular Surgery Physician
  • Tacoma, WA
National Provider Identifier
1164712931
Registry record updated Nov 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
License
MD60804832 Issued in WA
Practice address
1802 Yakima Ave Ste 204
Tacoma, WA 98405-5304
Phone
(253) 382-8540
Fax
(253) 382-8545
NPI assigned
Apr 14, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 22, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular Surgery Physician 2086S0129X MD60804832 WA Primary

Addresses

Primary practice location

1802 Yakima Ave Ste 204
Tacoma, WA 98405-5304

Mailing address

1802 Yakima Ave Ste 204
Tacoma, WA 98405-5304
Phone (253) 382-8540

Other identifiers 1

IdentifierTypeStateIssuer
2018866MedicaidWA

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address dnevidomskyte710842@fhsce.catholichealth.net Direct Franciscan Medical Group

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
I20180103003320 WA Practitioner - Vascular Surgery 1254644677 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Vascular Surgery
Education
Boston University School of Medicine, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Franciscan Medical GroupGroup PAC ID 0547173866, 1,400 clinicians

Practice addresses (Care Compare)

1802 Yakima Ave
Suite 204
Tacoma, WA 98405-5304
Phone (253) 382-8540

Hospital & facility affiliations

  • St Joseph Medical Center Hospital, Tacoma, WA, CCN 500108
  • St Francis Community Hospital Hospital, Federal Way, WA, CCN 500141
  • St Anthony Hospital Hospital, Gig Harbor, WA, CCN 500151
  • St Clare Hospital Hospital, Lakewood, WA, CCN 500021
  • St Michael Medical Center Hospital, Silverdale, WA, CCN 500039

Procedures performed for Medicare patients

ProcedureNumber of procedures
Varicose vein removal1-10
Leg revascularization (restoring blood flow)24
Removal of tissue1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
The Polyclinic PLLC Vascular Surgery CurrentSince Feb 1, 2018 Accepting new patients
Franciscan Medical Group CurrentSince Sep 20, 2021 Accepting new patients
Franciscan Medical Group CurrentSince Sep 20, 2021 Accepting new patients
Franciscan Medical Group Current Accepting new patients
The Polyclinic PLLC Current Accepting new patients
The Polyclinic CurrentSince Feb 1, 2018 Accepting new patients
Franciscan Health System Past Accepting new patients
Franciscan Medical Group Past Accepting new patients

Locations

1145 Broadway
Seattle, WA 98122

1812 S J St
Ste 102
Tacoma, WA 98405
Phone (253) 552-4900

1812 S J St
Ste 120
Tacoma, WA 98405
Phone (253) 428-2200

1802 Yakima Ave
Ste 204
Tacoma, WA 98405
Phone (206) 383-3325

Interoperability endpoints

  • Direct secure messaging: dnevidomskyte710842@fhsce.catholichealth.net
  • FHIR API: https://api.platform.athenahealth.com/3889/brand/1/csg/1/fhir/r4

Organizations & group practices 8

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 10

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": "1302739200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637539200000",
    "number": "1164712931",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1802 YAKIMA AVE STE 204",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984055304",
            "telephone_number": "253-382-8540",
            "fax_number": "253-382-8545"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1802 YAKIMA AVE STE 204",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984055304",
            "telephone_number": "253-382-8540",
            "fax_number": "253-382-8545"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NEVIDOMSKYTE",
        "first_name": "DAIVA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-04-14",
        "last_updated": "2021-11-22",
        "certification_date": "2021-11-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "WA",
            "license": "MD60804832",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2018866",
            "state": "WA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dnevidomskyte710842@fhsce.catholichealth.net",
            "affiliation": "Y",
            "affiliationName": "Franciscan Medical Group",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1802 Yakima Ave Ste 204",
            "city": "Tacoma",
            "state": "WA",
            "country_code": "US",
            "postal_code": "984055304",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Tacoma, WA

Sources for this page

Verify at the official NPI Registry.