NPIMap

Individual provider Active NPI

Conrad C Nievera Jr., MD

  • Clinical Neurophysiology Physician
  • Spokane, WA
National Provider Identifier
1346292018
Registry record updated Oct 9, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Neurophysiology PhysicianTaxonomy code 2084N0600X
License
MD60209370 Issued in WA
Practice address
400 E 5TH Ave
Spokane, WA 99202-1334
Phone
(509) 838-2531
NPI assigned
May 17, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2012

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X 35243 WI
Neurology Physician 2084N0400X MD60209370 WA
Clinical Neurophysiology Physician 2084N0600X MD60209370 WA Primary

Addresses

Primary practice location

400 E 5TH Ave
Spokane, WA 99202-1334

Mailing address

PO Box 3649
Spokane, WA 99220-3649
Phone (509) 838-2531

Other identifiers 2

IdentifierTypeStateIssuer
34312700MedicaidWI
003806261COtherHUMANA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA, SD, TN3 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20110802000397 WA Practitioner - Neurology 8325123318 Reassigns benefits to 1 organization
I20210726003089 SD Practitioner - Neurology 8325123318 Reassigns benefits to 1 organization
I20241015000762 TN Practitioner - Neurology 8325123318

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
Other, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Multicare Health SystemGroup PAC ID 7719899897, 2,312 clinicians
Monument Health Rapid City Hospital IncGroup PAC ID 6002729506, 560 clinicians

Practice addresses (Care Compare)

4700 Point Fosdick Dr
Gig Harbor, WA 98335-1706

677 Cathedral Dr
Suite 200
Rapid City, SD 57701-7389
Phone (605) 755-4150

Hospital & facility affiliations

  • Monument Health Rapid City Hospital Hospital, Rapid City, SD, CCN 430077
  • Deaconess Medical Center Hospital, Spokane, WA, CCN 500044
  • Monument Health Spearfish Hospital Hospital, Spearfish, SD, CCN 430048
  • Monument Health Sturgis Hospital Hospital, Sturgis, SD, CCN 431321
  • Multicare Valley Hospital Hospital, Spokane Valley, WA, CCN 500119

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
35243WIMDNeurology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Monument Health Rapid City Hospital, Inc Current Accepting new patients
Multicare Health System CurrentSince Mar 1, 2018 Accepting new patients
Neurotech, LLC CurrentSince Sep 5, 2018 Accepting new patients
Monument Health Rapid City Hospital Inc CurrentSince Jul 1, 2021 Accepting new patients
Monument Health Rapid City Hospital, Inc. CurrentSince Jul 1, 2021 Accepting new patients
Multicare Health System Current Accepting new patients
Multicare Health System Family Medicine CurrentSince Mar 1, 2018 Accepting new patients

Locations

677 Cathedral Dr
Ste 200
Rapid City, SD 57701
Phone (605) 343-9224

353 Fairmont Blvd
Rapid City, SD 57701
Phone (605) 719-1000

4700 Point Fosdick Dr
Ste 104
Gig Harbor, WA 98335
Phone (253) 459-7590

910 W 5th Ave
Ste 1000
Spokane, WA 99204
Phone (509) 342-3200

311 S L St
Tacoma, WA 98405
Phone (253) 403-1444

2830 Ramada Way
Ste 204
Green Bay, WI 54304
Phone (262) 875-6633

626 W Moreland Blvd
Waukesha, WI 53188
Phone (262) 754-0898

Interoperability endpoints

  • Direct secure messaging: cnievera330798@direct.multicare.org

Organizations & group practices 7

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 23

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

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1147824000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1349740800000",
    "number": "1346292018",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3649",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992203649",
            "telephone_number": "509-838-2531"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 E 5TH AVE",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992021334",
            "telephone_number": "509-838-2531"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NIEVERA",
        "first_name": "CONRAD",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-17",
        "last_updated": "2012-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "WI",
            "license": "35243",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "WA",
            "license": "MD60209370",
            "primary": false
        },
        {
            "code": "2084N0600X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Clinical Neurophysiology",
            "state": "WA",
            "license": "MD60209370",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "34312700",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HUMANA",
            "identifier": "003806261C",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Spokane, WA

Sources for this page

Verify at the official NPI Registry.