NPIMap

Individual provider Active NPI

Misti Michelle Song, M.D.

  • Internal Medicine Physician
  • Las Vegas, NV
National Provider Identifier
1184602682
Registry record updated Jun 1, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
9942 Issued in NV
Practice address
1707 W Charleston Blvd
230
Las Vegas, NV 89102-2351
Phone
(702) 671-5060
Fax
(702) 384-6609
NPI assigned
Jan 4, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 1, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 9942 NV Primary

Addresses

Primary practice location

1707 W Charleston Blvd
230
Las Vegas, NV 89102-2351

Mailing address

3016 W Charleston Blvd Ste 100
Las Vegas, NV 89102-1973
Phone (702) 780-7118

Other identifiers 2

IdentifierTypeStateIssuer
002018447MedicaidNV
100500484MedicaidNV

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV
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
I20100505000308 NV Practitioner - Internal Medicine 3870621246 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Loma Linda University School of Medicine, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Unlv MedicineGroup PAC ID 4183991458, 177 clinicians

Practice addresses (Care Compare)

1707 W Charleston Blvd
Suite 230
Las Vegas, NV 89102-2353
Phone (702) 671-6412

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
9942NVMDMassage Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Unlv Medicine Internal Medicine CurrentSince Jul 1, 2017 Accepting new patients
Unlv Medicine CurrentSince Jul 1, 2017 Accepting new patients
University Medical Center of Southern Nevada Past Accepting new patients

Locations

1707 W Charleston Blvd
Ste 110
Las Vegas, NV 89102
Phone (702) 671-2300

1707 W Charleston Blvd
Ste 220
Las Vegas, NV 89102
Phone (702) 671-5070

1800 W Charleston Blvd
Las Vegas, NV 89102
Phone (702) 207-8253

1707 W Charleston Blvd
Ste 230
Las Vegas, NV 89102
Phone (702) 671-5060

2410 Fire Mesa St
Ste 180
Las Vegas, NV 89128
Phone (702) 202-2700

5380 S Rainbow Blvd
Ste 324
Las Vegas, NV 89118
Phone (702) 992-6828

3016 W Charleston Blvd
Ste 100
Las Vegas, NV 89102
Phone (702) 780-2315

Interoperability endpoints

  • Direct secure messaging: msong18740@direct.umcsn.com

Organizations & group practices 3

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 12

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": "1136332800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1590969600000",
    "number": "1184602682",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3016 W CHARLESTON BLVD STE 100",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891021973",
            "telephone_number": "702-780-7118",
            "fax_number": "702-671-6430"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1707 W CHARLESTON BLVD",
            "address_2": "230",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891022351",
            "telephone_number": "702-671-5060",
            "fax_number": "702-384-6609"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SONG",
        "first_name": "MISTI",
        "middle_name": "MICHELLE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-04",
        "last_updated": "2020-06-01",
        "certification_date": "2020-06-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NV",
            "license": "9942",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002018447",
            "state": "NV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100500484",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

Verify at the official NPI Registry.