NPIMap

Organization Active NPI

Mark D Nellermoe Professional Service Corporation

  • Podiatrist
  • University Place, WA
National Provider Identifier
1194145094
Registry record updated Jun 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
PO00000507 Issued in WA
Legal business name
MARK D NELLERMOE PROFESSIONAL SERVICE CORPORATION
Practice address
3929 Bridgeport Way W Ste 308
University Place, WA 98466-4455
Phone
(253) 627-4181
Fax
(253) 272-5922
NPI assigned
Apr 18, 2014
Last updated
Jun 11, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2025

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

Authorized official

Name
Dr. Mark D Nellermoe, DPMNPI 1386733541
Title
Owner
Phone
(253) 627-4181

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Podiatrist 213E00000X PO00000507 WA Primary

Addresses

Primary practice location

3929 Bridgeport Way W Ste 308
University Place, WA 98466-4455

Mailing address

3929 Bridgeport Way W Ste 308
University Place, WA 98466-4455
Phone (253) 627-4181

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140903000307 WA Part B Supplier - Clinic/Group Practice 9436377504 Receives reassigned benefits from 1 practitioner
Practice locations: University Place, WA

National Provider Directory

National Provider Directory

Locations

7716 Bridgeport Way W
Tacoma, WA 98499
Phone (253) 581-0714

9108 Lakewood Dr SW
Tacoma, WA 98499
Phone (253) 581-6202

3609 Sunset Dr W
University Place, WA 98466
Phone (253) 565-4468

Practitioners & affiliated clinicians

Practitioners 17

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 17

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1397779200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1749600000000",
    "number": "1194145094",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3929 BRIDGEPORT WAY W STE 308",
            "city": "UNIVERSITY PLACE",
            "state": "WA",
            "postal_code": "984664455",
            "telephone_number": "253-627-4181",
            "fax_number": "253-272-5922"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3929 BRIDGEPORT WAY W STE 308",
            "city": "UNIVERSITY PLACE",
            "state": "WA",
            "postal_code": "984664455",
            "telephone_number": "253-627-4181",
            "fax_number": "253-272-5922"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARK D NELLERMOE PROFESSIONAL SERVICE CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-18",
        "last_updated": "2025-06-11",
        "certification_date": "2025-06-11",
        "status": "A",
        "authorized_official_last_name": "NELLERMOE",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "253-627-4181",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "WA",
            "license": "PO00000507",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in University Place, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.