Individual provider Active NPI

Avnee Vinay Nulkar, MD

  • Pediatrics Physician
  • Vancouver, WA
National Provider Identifier
1366022733
Registry record updated Jun 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
61541209 Issued in WA
Practice address
2525 NE 139TH St
Vancouver, WA 98686-2719
Phone
(408) 307-6297
NPI assigned
Apr 10, 2021
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 16, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Pediatrics Physician 208000000X 61541209 WA Primary

Addresses

Primary practice location

2525 NE 139TH St
Vancouver, WA 98686-2719

Mailing address

538 Hubbard Ave
Santa Clara, CA 95051-5834
Phone (408) 307-6297

Other practice location 1

750 E Adams St
Syracuse, NY 13210-2306
Phone (315) 464-4357

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241113000831 WA Practitioner - Pediatric Medicine 7012441041 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
61541209WAMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The Vancouver Clinic Inc PS Current Accepting new patients
The Vancouver Clinic Inc PS CurrentSince Sep 6, 2024 Accepting new patients
The Vancouver Clinic Inc PS CurrentSince Sep 6, 2024 Accepting new patients
The Vancouver Clinic Pharmacy Past Accepting new patients

Locations

2525 NE 139th St
Ste 110
Vancouver, WA 98686

700 NE 87th Ave
Vancouver, WA 98664
Phone (360) 397-1500

2525 NE 139th St
Vancouver, WA 98686
Phone (360) 397-1500

Interoperability endpoints

  • Direct secure messaging: anulkar24341@tvc-direct.org

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.

NPI Registry JSON

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

{
    "created_epoch": "1618012800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718496000000",
    "number": "1366022733",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "538 HUBBARD AVE",
            "city": "SANTA CLARA",
            "state": "CA",
            "postal_code": "950515834",
            "telephone_number": "408-307-6297"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2525 NE 139TH ST",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986862719",
            "telephone_number": "408-307-6297"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "750 E Adams St",
            "address_purpose": "LOCATION",
            "city": "Syracuse",
            "state": "NY",
            "postal_code": "132102306",
            "country_code": "US",
            "telephone_number": "315-464-4357",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NULKAR",
        "first_name": "AVNEE",
        "middle_name": "VINAY",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-04-10",
        "last_updated": "2024-06-16",
        "certification_date": "2024-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "WA",
            "license": "61541209",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vancouver, WA

Sources for this page

Verify at the official NPI Registry.