NPIMap

Individual provider Active NPI

Geoffrey Owen McNicoll, M.D.

  • Family Medicine Physician
  • Puyallup, WA
National Provider Identifier
1255438586
Registry record updated Mar 31, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD60180279 Issued in WA
Practice address
15214 Canyon Rd E
Ste 100
Puyallup, WA 98375-7472
Phone
(253) 539-4200
Fax
(253) 539-6005
NPI assigned
Sep 20, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 31, 2011

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X EC081117 ME
Family Medicine Physician 207Q00000X MD60180279 WA Primary

Addresses

Primary practice location

15214 Canyon Rd E
Ste 100
Puyallup, WA 98375-7472

Mailing address

15214 Canyon Rd E
Ste 100
Puyallup, WA 98375-7472
Phone (253) 539-4200

Other identifiers 2

IdentifierTypeStateIssuer
0273458OtherWASTATE L&I
0273460OtherWASTATE L&I

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
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
I20110210000951 WA Practitioner - Family Practice 3274713045 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Franciscan Medical GroupGroup PAC ID 0547173866, 1,400 clinicians
Select Outpatient Services IncGroup PAC ID 4082868815, 750 clinicians
Select Rehabilitation, LLCGroup PAC ID 9032020490, 1,935 clinicians

Practice addresses (Care Compare)

15214 Canyon Rd E
Suite 100
Puyallup, WA 98375-7472
Phone (253) 539-4200

2600 Compass Rd
Glenview, IL 60026-8001

Hospital & facility affiliations

  • Puget Sound Home Health Home health agency, Tacoma, WA, CCN 507101
  • CHI Franciscan Health at Home Home health agency, University Place, WA, CCN 507124
  • Centerwell Home Health Home health agency, Tacoma, WA, CCN 507031
  • St Joseph Medical Center Hospital, Tacoma, WA, CCN 500108
  • St Clare Hospital Hospital, Lakewood, WA, CCN 500021
  • Tacoma General Allenmore Hospital Hospital, Tacoma, WA, CCN 500129
  • St Anthony Hospital Hospital, Gig Harbor, WA, CCN 500151
  • St Francis Community Hospital Hospital, Federal Way, WA, CCN 500141

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
EC081117MEMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
Franciscan Medical Group Family Medicine CurrentSince Jan 3, 2011 Accepting new patients
Franciscan Medical Group Current Accepting new patients
Franciscan Medical Group Family Medicine Past Accepting new patients

Locations

21 NE Romance Hill Rd
Ste 105
Belfair, WA 98528
Phone (360) 277-2950

15214 Canyon Rd E
Ste 100
Puyallup, WA 98375
Phone (253) 539-4200

5741 N 26th St
Unit 115
Tacoma, WA 98407
Phone (253) 756-3737

1812 S J St
Ste 120
Tacoma, WA 98405
Phone (253) 428-2200

Organizations & group practices 4

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 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1301529600000",
    "number": "1255438586",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15214 CANYON RD E",
            "address_2": "STE 100",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983757472",
            "telephone_number": "253-539-4200",
            "fax_number": "253-539-6005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15214 CANYON RD E",
            "address_2": "STE 100",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983757472",
            "telephone_number": "253-539-4200",
            "fax_number": "253-539-6005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCNICOLL",
        "first_name": "GEOFFREY",
        "middle_name": "OWEN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-20",
        "last_updated": "2011-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "ME",
            "license": "EC081117",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "MD60180279",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE L&I",
            "identifier": "0273458",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE L&I",
            "identifier": "0273460",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Puyallup, WA

Sources for this page

Verify at the official NPI Registry.