Individual provider Active NPI

Nathan Mielke, DO

  • Diagnostic Radiology Physician
  • Round Rock, TX
National Provider Identifier
1205241072
Registry record updated Aug 20, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
S2116 Issued in TX
Practice address
300 University Blvd
Round Rock, TX 78665-1032
Phone
(512) 509-0100
Fax
(512) 218-6330
NPI assigned
Jun 30, 2014
Last updated
Aug 20, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X S2116 TX Primary

Addresses

Primary practice location

300 University Blvd
Round Rock, TX 78665-1032

Mailing address

PO Box 844658
Dallas, TX 75284-4658

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address nmielke696118@direct.sw.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20190808002854 TX Practitioner - Diagnostic Radiology 9931324829 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Scott and White ClinicGroup PAC ID 8123923604, 2,426 clinicians

Practice addresses (Care Compare)

11209 S Interstate Hwy 35
Baylor Scott and White Clinic Onion
Austin, TX 78747-1712
Phone (512) 654-4700

1605 S 31St St
Baylor Scott and White Center for Dia
Temple, TX 76508-0001
Phone (254) 215-0100

1701 E Pflugerville Pkwy
Baylor Scott and White Clinic Pflug
Pflugerville, TX 78660-8990
Phone (512) 259-6000

2401 S 31 St
Temple, TX 76508-0001
Phone (254) 724-2459

2401 S 31St St BLDG
35 Baylor Scott and White Roney Bone and
Temple, TX 76508-0001
Phone (254) 724-2663

2600 E Pflugerville Pkwy
Pflugerville, TX 78660-5999

300 University Blvd
Round Rock, TX 78665-1032
Phone (512) 509-0200

302 University Blvd
Round Rock, TX 78665-1032
Phone (512) 509-0200

425 University Blvd
Round Rock, TX 78665-1053
Phone (512) 509-0200

4945 Williams Dr
Baylor Scott and White Clinic Georg
Georgetown, TX 78633-2008
Phone (512) 819-0500

5000 W Slaughter LN 100 BLDG
6 Baylor Scott and White Clinic Austi
Austin, TX 78749-4015
Phone (512) 291-8002

810 W U Ave
Temple, TX 76508-0001
Phone (254) 724-2585

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
S2116TXMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Btdi JV, LLP CurrentSince Jul 1, 2020 Accepting new patients
Btdi JV, LLP CurrentSince Jul 1, 2020 Accepting new patients
The University of Texas Southwestern Medical Center at Dallas CurrentSince Jul 1, 2019 Accepting new patients
Btdi JV, LLP CurrentSince Jul 3, 2020 Accepting new patients
Scott and White Clinic Diagnostic Radiology CurrentSince May 8, 2020 Accepting new patients
Btdi JV, LLP CurrentSince Jul 1, 2020 Accepting new patients
University of Texas Southwestern Medical Center at Dallas Current Accepting new patients
University of Texas Southwestern Medical Center at Dallas Diagnostic Radiology CurrentSince Jul 1, 2019 Accepting new patients
Healthtexas Provider Network Past Accepting new patients
Scott & White Hospital - Taylor Past Accepting new patients
Btdi JV, LLP PastSince Jul 1, 2020 Accepting new patients

Locations

2350 N Stemmons Fwy
Dallas, TX 75207
Phone (469) 488-7100

810 W Highway 71
Marble Falls, TX 78654
Phone (830) 201-7100

1701 E Pflugerville Pkwy
Pflugerville, TX 78660
Phone (512) 259-6000

300 University Blvd
Round Rock, TX 78665
Phone (512) 509-0100

2401 S 31st St
Temple, TX 76508
Phone (254) 724-2459

5323 Harry Hines Blvd
Ut Southwest Medical Center, TX 75390

Organizations & group practices 12

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

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": "1404086400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597881600000",
    "number": "1205241072",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 844658",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752844658"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 UNIVERSITY BLVD",
            "city": "ROUND ROCK",
            "state": "TX",
            "postal_code": "786651032",
            "telephone_number": "512-509-0100",
            "fax_number": "512-218-6330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIELKE",
        "first_name": "NATHAN",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-06-30",
        "last_updated": "2020-08-20",
        "certification_date": "2020-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "TX",
            "license": "S2116",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "nmielke696118@direct.sw.org",
            "affiliation": "N",
            "address_1": "300 University Blvd",
            "city": "Round Rock",
            "state": "TX",
            "country_code": "US",
            "postal_code": "786651032",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Round Rock, TX

Sources for this page

Verify at the official NPI Registry.