Individual provider Active NPI

Justin Daniel Wheeler, MD

  • Family Medicine Physician
  • Olympia, WA
National Provider Identifier
1265564009
Registry record updated Apr 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD60889819 Issued in WA
Practice address
1620 Cooper Point Rd SW
Olympia, WA 98502-5736
Phone
(360) 486-6710
Fax
(360) 705-0269
NPI assigned
Mar 9, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MD60889819 WA Primary

Addresses

Primary practice location

1620 Cooper Point Rd SW
Olympia, WA 98502-5736

Mailing address

1620 Cooper Point Rd SW
Olympia, WA 98502-5736
Phone (360) 486-6710

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jwheeler1039321@wm.providencedirect.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO, WA2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20080825000537 CO Practitioner - Family Practice 7416022504 Reassigns benefits to 1 organization
I20190701001371 WA Practitioner - Family Practice 7416022504 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Warren Alpert Medical School of Brown University, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Providence Health and Services WashingtonGroup PAC ID 6709782600, 480 clinicians

Practice addresses (Care Compare)

1620 Cooper Point Rd SW
Olympia, WA 98502-5736
Phone (306) 486-6710

Hospital & facility affiliations

  • Providence St Peter Hospital Hospital, Olympia, WA, CCN 500024
  • Providence Centralia Hospital Hospital, Centralia, WA, CCN 500019

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Health & Services Washington Family Medicine CurrentSince May 27, 2019 Accepting new patients
Clinica Campesina Family Health Services CurrentSince Jun 1, 2013 Accepting new patients
Clinica Campesina Family Health Services Current Accepting new patients
Providence Health & Services Washington Past Accepting new patients

Locations

1735 S Public Rd
Lafayette, CO 80026
Phone 30366530361061

1345 Plaza Ct N
Ste 1A
Lafayette, CO 80026
Phone (303) 665-2962

1735 S Public Rd
Ste 203
Lafayette, CO 80026

1620 Cooper Point Rd SW
Olympia, WA 98502
Phone (360) 486-6710

525 Lilly Rd NE
Olympia, WA 98506
Phone (360) 413-8550

Interoperability endpoints

  • Direct secure messaging: rocky.mountain@corhio.medicity.net

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 3

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": "1173398400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1619654400000",
    "number": "1265564009",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1620 COOPER POINT RD SW",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985025736",
            "telephone_number": "360-486-6710",
            "fax_number": "360-705-0269"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1620 COOPER POINT RD SW",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985025736",
            "telephone_number": "360-486-6710",
            "fax_number": "360-705-0269"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WHEELER",
        "first_name": "JUSTIN",
        "middle_name": "DANIEL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-09",
        "last_updated": "2021-04-29",
        "certification_date": "2021-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "MD60889819",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jwheeler1039321@wm.providencedirect.org",
            "affiliation": "N",
            "address_1": "1620 Cooper Point Rd SW",
            "city": "Olympia",
            "state": "WA",
            "country_code": "US",
            "postal_code": "985025736",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Olympia, WA

Sources for this page

Verify at the official NPI Registry.