Miroslav Backonja, MD

Primary specialty

Pain Medicine (Psychiatry & Neurology) PhysicianTaxonomy code 2084P2900X

License

MD60527403 Issued in WA

Practice address

4225 Roosevelt Way NE FL 4
Seattle, WA 98105-6099

Phone

(206) 598-4282

NPI assigned

Feb 2, 2006

Last updated

Apr 25, 2016By the provider in NPPES

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WI

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1138838400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1461542400000",
    "number": "1306818513",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 50095",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981455095",
            "telephone_number": "206-520-5700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4225 ROOSEVELT WAY NE FL 4",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981056099",
            "telephone_number": "206-598-4282"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BACKONJA",
        "first_name": "MIROSLAV",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-02",
        "last_updated": "2016-04-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P2900X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Pain Medicine",
            "state": "WA",
            "license": "MD60527403",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1306818513",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Charles A Backman, D.D.S., M.S.D.
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• Mark L Backus, M.D.
• Brittany Seabury Bacon, M.A.
• Erica Renee Bacon

• Pain Medicine (Psychiatry & Neurology) Physician in Seattle, WA
• Providers in Seattle, WA by specialty
• Pain Medicine (Psychiatry & Neurology) Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2016; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.