Malik Ahmed Nizamuddin, D.O

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

OP61054222 Issued in WA

Practice address

2930 Maple St
Everett, WA 98201-3832

Phone

(425) 261-1500

Fax

(425) 261-1515

NPI assigned

Apr 19, 2017

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Internal Medicine

Education

Pacific NW Un of HS, Col of Osteopathic Medicine, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Kaiser Foundation Health Plan of WashingtonGroup PAC ID 9032022579, 1,519 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Providence Regional Medical Center Everett Hospital, Everett, WA, CCN 500014

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mnizamuddin239049@ghc.direct-ci.net

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.

• Kaiser Foundation Health Plan of Washington

  • Multi-Specialty Clinic/Center
  • Seattle, WA
  • NPI 1396810701
  Medicare reassignment Care Compare group NPD
• Hospitalist Medicine Physicians of California - San Leandro, PC

  • Internal Medicine Physician
  • Mount Vernon, WA
  • NPI 1689210874
  Medicare reassignment NPD
• South Sound Inpatient Physicians PLLC

  • Internal Medicine Physician
  • Vancouver, WA
  • NPI 1023285756
  Medicare reassignment NPD
• Cogent Healthcare of Washington, PC

  • Internal Medicine Physician
  • Vancouver, WA
  • NPI 1861430522
  NPD
• Kaiser Foundation Health Plan of Washington

  • Multi-Specialty Clinic/Center
  • Everett, WA
  • NPI 1386935351
  NPD
• Kaiser Foundation Health Plan of Washington

  • Multi-Specialty Clinic/Center
  • Renton, WA
  • NPI 1669619870
  NPD
• Hospitalist Medicine Physicians of California-San Bernardino, PC

  • Internal Medicine Physician
  • Bakersfield, CA
  • NPI 1376188078
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Providence Health & Services-Wa

  • Hospitalist Physician
  • Everett, WA
  • NPI 1649615220
  Care Compare affiliation
• Providence Health & Services-Wa

  • General Acute Care Hospital
  • Everett, WA
  • NPI 1700037801
  Care Compare affiliation

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

{
    "created_epoch": "1492560000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1619568000000",
    "number": "1235663063",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2930 MAPLE ST",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982013832",
            "telephone_number": "425-261-1500",
            "fax_number": "425-261-1515"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2930 MAPLE ST",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982013832",
            "telephone_number": "425-261-1500",
            "fax_number": "425-261-1515"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1415 E Kincaid St",
            "address_purpose": "LOCATION",
            "city": "Mount Vernon",
            "state": "WA",
            "postal_code": "982744126",
            "country_code": "US",
            "telephone_number": "360-814-2115",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NIZAMUDDIN",
        "first_name": "MALIK",
        "middle_name": "AHMED",
        "credential": "D.O",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-04-19",
        "last_updated": "2021-04-28",
        "certification_date": "2020-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WA",
            "license": "OP61054222",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwa.kp.org:14430/Interconnect-CE-PRD/wcf/epic.community.hie/xcpdrespondinggatewaysync",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "2930 Maple St",
            "city": "Everett",
            "state": "WA",
            "country_code": "US",
            "postal_code": "982013832",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Richard J. Nishman, M.D.
• Corina Nistor, MD
• Brian K. Nitta, OTR/L
• Odessa Marie Nix
• Bruce Frederick Nixon, DDS
• Quynh-Nhu Pham Nizza, M.D.
• Joseph M Njenga
• Olivia Danielle Noell
• Rebecca Bryn Nolan, M.D.
• Rita Ellen Nolan

• Internal Medicine Physician in Everett, WA
• Providers in Everett, WA by specialty
• Internal Medicine Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.