Active NPI
Nishant Gautam
- Family Medicine Physician
- Longview, WA
National Provider Identifier
1295416741
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- MD70045885
- Practice address
- 1718 E Kessler Blvd
Longview, WA 98632-1842 - Phone
- (360) 747-5800
- Fax
- (360) 575-3846
- NPI assigned
- Jul 27, 2023
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | MD70045885 | WA | Primary |
Addresses
Primary practice location
1718 E Kessler Blvd
Longview, WA 98632-1842
Mailing address
4864 Jackson St
Monroe, LA 71202-6400
Other practice location 1
4864 Jackson St
Monroe, LA 71202-6400
Phone (318) 330-7600
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: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Family Practice
- Education
- Other, 2015
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
12914 NE 37TH St
Vancouver, WA 98682-7626
1718 E Kessler Blvd
Longview, WA 98632-1842
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD70045885 | WA | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Peacehealth | Family Medicine | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1690416000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1778025600000",
"number": "1295416741",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4864 JACKSON ST",
"city": "MONROE",
"state": "LA",
"postal_code": "712026400"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1718 E KESSLER BLVD",
"city": "LONGVIEW",
"state": "WA",
"postal_code": "986321842",
"telephone_number": "360-747-5800",
"fax_number": "360-575-3846"
}
],
"practiceLocations": [
{
"address_1": "4864 Jackson St",
"address_purpose": "LOCATION",
"city": "Monroe",
"state": "LA",
"postal_code": "712026400",
"country_code": "US",
"telephone_number": "318-330-7600",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "GAUTAM",
"first_name": "NISHANT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-07-27",
"last_updated": "2026-05-06",
"certification_date": "2026-05-06",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "WA",
"license": "MD70045885",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Longview, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2026; 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.