Michael A Nissenbaum, MD

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

46969 Issued in OK

Practice address

940 NE 13TH St # 3G3210
Oklahoma City, OK 73104-5008

Phone

(405) 271-5125

Fax

(405) 271-3462

NPI assigned

Dec 23, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 7

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in VT, NH, PA, TN, NJ5 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 5

Specialty

Diagnostic Radiology

Education

Other, 1983

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Dartmouth-Hitchcock ClinicGroup PAC ID 4183537509, 1,445 clinicians

Red River Consultants IncGroup PAC ID 1355303363, 56 clinicians

Mary Washington Healthcare Providers LLCGroup PAC ID 1456629369, 264 clinicians

Valley Physician Services PCGroup PAC ID 3577857333, 593 clinicians

Virtual Radiologic Professionals LLCGroup PAC ID 4981608817, 392 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Mary Washington Hospital Hospital, Fredericksburg, VA, CCN 490022
• Valley Hospital Hospital, Paramus, NJ, CCN 310012
• Stafford Hospital, LLC Hospital, Stafford, VA, CCN 490140
• Copley Hospital Hospital, Morrisville, VT, CCN 471305
• Southwestern Vermont Medical Center Hospital, Bennington, VT, CCN 470012

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/GCFJBA
• FHIR API: https://fhir-myrecord.cerner.com/r4/d9dc001d-1bc5-42f9-bd4d-eb79208fd32a/

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.

• Dartmouth-Hitchcock Clinic

  • Internal Medicine Physician
  • Lebanon, NH
  • NPI 1548210198

  Diagnostic Radiology, VT

  Medicare reassignment Care Compare group NPD
• Mary Washington Healthcare Providers LLC

  • Hospitalist Physician
  • Fredericksburg, VA
  • NPI 1750826277

  Diagnostic Radiology, VT

  Medicare reassignment Care Compare group NPD
• Red River Consultants, Inc

  • Diagnostic Radiology Physician
  • Shreveport, LA
  • NPI 1902877426

  VT

  Medicare reassignment Care Compare group NPD
• Valley Physician Services PC

  • Internal Medicine Physician
  • Paramus, NJ
  • NPI 1467815928

  VT

  Medicare reassignment Care Compare group NPD
• Virtual Radiologic Professionals, LLC

  • Diagnostic Radiology Physician
  • Edina, MN
  • NPI 1932342029

  VT

  Medicare reassignment Care Compare group NPD
• Carlos G Otis Health Care Center Inc

  • Rural Health Clinic/Center
  • Townshend, VT
  • NPI 1124049960
  Medicare reassignment NPD
• Carlos G. Otis Health Care Center Inc.

  • Critical Access Hospital
  • Townshend, VT
  • NPI 1255337473
  Medicare reassignment NPD
• Mary Hitchcock Memorial Hospital

  • General Acute Care Hospital
  • Lebanon, NH
  • NPI 1023092053
  Medicare reassignment NPD
• Rwjbh Emergency Medicine Associates, LLC

  • Emergency Medicine Physician
  • Somerset, NJ
  • NPI 1912510041
  Medicare reassignment NPD
• Rwjbh Observation Associates LLC

  • Emergency Medicine Physician
  • Livingston, NJ
  • NPI 1760095806

  Diagnostic Radiology

  Medicare reassignment NPD
• Michael a. Nissenbaum, MD, PA

  • Diagnostic Radiology Physician
  • Fort Kent, ME
  • NPI 1184857716
  NPD (past) Authorized official
• Carlos G Otis Health Care Center Inc

  • Medicare Defined Swing Bed Hospital Unit
  • Townshend, VT
  • NPI 1093843328
  NPD

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

• Copley Hospital, Inc.

  • Critical Access Hospital
  • Morrisville, VT
  • NPI 1568414365
  Care Compare affiliation
• Mary Washington Hospital Inc.

  • General Acute Care Hospital
  • Fredericksburg, VA
  • NPI 1942288527
  Care Compare affiliation
• Mary Washington Hospital, Inc.

  • Cardiovascular Disease Physician
  • Fredericksburg, VA
  • NPI 1013089879

  Hospital

  Care Compare affiliation
• Mary Washington Hospital, Inc.

  • Home Health Agency
  • Fredericksburg, VA
  • NPI 1407814163

  Hospital

  Care Compare affiliation
• Southwestern Vermont Medical Center Inc.

  • General Acute Care Hospital
  • Bennington, VT
  • NPI 1205865789
  Care Compare affiliation
• Stafford Hospital, LLC

  • General Acute Care Hospital
  • Stafford, VA
  • NPI 1043343304
  Care Compare affiliation
• The Valley Hospital Inc.

  • General Acute Care Hospital
  • Paramus, NJ
  • NPI 1013912633
  Care Compare affiliation

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

{
    "created_epoch": "1135296000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1787184000000",
    "number": "1356328975",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3841 GREEN HILLS VILLAGE DR STE 200",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372152691"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "940 NE 13TH ST # 3G3210",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731045008",
            "telephone_number": "405-271-5125",
            "fax_number": "405-271-3462"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3600 Minnesota Dr Ste 800",
            "address_purpose": "LOCATION",
            "city": "Edina",
            "state": "MN",
            "postal_code": "554357915",
            "country_code": "US",
            "telephone_number": "952-595-1100",
            "fax_number": "612-294-4903",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3601 The Vanderbilt Clinic",
            "address_purpose": "LOCATION",
            "city": "Nashville",
            "state": "TN",
            "postal_code": "372325349",
            "country_code": "US",
            "telephone_number": "615-322-3000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "101 Hospital Center Blvd",
            "address_purpose": "LOCATION",
            "city": "Stafford",
            "state": "VA",
            "postal_code": "225546200",
            "country_code": "US",
            "telephone_number": "540-741-5610",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1001 Sam Perry Blvd",
            "address_purpose": "LOCATION",
            "city": "Fredericksburg",
            "state": "VA",
            "postal_code": "224014453",
            "country_code": "US",
            "telephone_number": "540-741-5610",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1 Medical Center Dr",
            "address_purpose": "LOCATION",
            "city": "Lebanon",
            "state": "NH",
            "postal_code": "037560001",
            "country_code": "US",
            "telephone_number": "603-650-5000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NISSENBAUM",
        "first_name": "MICHAEL",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-23",
        "last_updated": "2026-08-20",
        "certification_date": "2026-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NJ",
            "license": "25IA12454600",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "VA",
            "license": "0101287300",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "LA",
            "license": "305724",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "VT",
            "license": "042.0007498",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NH",
            "license": "EL31162",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "OK",
            "license": "46969",
            "primary": true
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "TN",
            "license": "72052",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "vumc@direct.vumc.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Health Information Service Provider",
            "address_1": "3601 The Vanderbilt Clinic",
            "city": "Nashville",
            "state": "TN",
            "country_code": "US",
            "postal_code": "372325349",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Sandra J. Nikkel, M.S.W., L.C.S.W.
• Sam Nimo
• Ryan David Nipp, M.D.
• Niraj K. Prasad, M.D., P.C.
• Robert B Nisbet, MD
• Fidelia Nabi Nitah, PMHNP-BC, FNP-BC
• Peyton Nitz
• Marcy Niver
• Ashley Dorner Nix, CRNP
• Carly Nix, PT

• Diagnostic Radiology Physician in Oklahoma City, OK
• Providers in Oklahoma City, OK by specialty
• Diagnostic Radiology Physician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 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.

Verify at the official NPI Registry.