Individual provider Active NPI

Mary Elizabeth Micikas, FNP

  • Nurse Practitioner
  • Seattle, WA
National Provider Identifier
1225540545
Registry record updated Jun 29, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
AP60801941 Issued in WA
Practice address
515 Minor Ave Ste 170
Seattle, WA 98104
Phone
(206) 386-9500
Fax
(206) 386-9605
NPI assigned
Oct 26, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 29, 2018

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X RN60800561 WA
Family Nurse Practitioner 363LF0000X AP60801941 WA
Nurse Practitioner 363L00000X AP60801941 WA Primary

Addresses

Primary practice location

515 Minor Ave Ste 170
Seattle, WA 98104

Mailing address

PO Box 25608
Salt Lake City, UT 84125-0608
Phone (206) 320-4476

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180405000108 WA Practitioner - Nurse Practitioner 0345503306 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Seattle Roots Community HealthGroup PAC ID 8628966173, 50 clinicians

Practice addresses (Care Compare)

550 16TH Ave
Suite 100
Seattle, WA 98122-5636
Phone (206) 299-1900

Hospital & facility affiliations

  • Swedish Medical Center / Cherry Hill Hospital, Seattle, WA, CCN 500025

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Seattle Roots Community Health CurrentSince Dec 1, 2018 Accepting new patients
Seattle Roots Community Health CurrentSince Dec 1, 2018 Accepting new patients
Seattle Roots Community Health Current Accepting new patients
Seattle Roots Community Health Past Accepting new patients
Seattle Roots Community Health Past Accepting new patients

Locations

2101 E Yesler Way
Ste 150
Seattle, WA 98122
Phone (206) 299-1900

301 21st Ave E
Seattle, WA 98112
Phone (206) 709-7190

2410 E Cherry St
Seattle, WA 98122
Phone (206) 299-1900

500 19th Ave E
Seattle, WA 98112
Phone (206) 299-1600

550 16th Ave
Ste 100
Seattle, WA 98122
Phone (206) 299-1900

2101 E Yesler Way
Ste 100
Seattle, WA 98122
Phone (206) 987-7200

Interoperability endpoints

  • Direct secure messaging: mmicikas272555@direct.ochin.org

Organizations & group practices 5

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 1

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": "1508976000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1530230400000",
    "number": "1225540545",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 25608",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841250608",
            "telephone_number": "206-320-4476",
            "fax_number": "206-568-7043"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "515 MINOR AVE STE 170",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "98104",
            "telephone_number": "206-386-9500",
            "fax_number": "206-386-9605"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MICIKAS",
        "first_name": "MARY",
        "middle_name": "ELIZABETH",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-10-26",
        "last_updated": "2018-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "WA",
            "license": "RN60800561",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WA",
            "license": "AP60801941",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WA",
            "license": "AP60801941",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Seattle, WA

Sources for this page

Verify at the official NPI Registry.