Individual provider Active NPI

Brian Joseph Zeithaml, M.D.

  • Surgery Physician
  • Vancouver, WA
National Provider Identifier
1366738312
Registry record updated Sep 20, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
MD60848138 Issued in WA
Practice address
505 NE 87TH Ave Ste 301
Vancouver, WA 98664-1965
Phone
(360) 514-1854
NPI assigned
Jun 28, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 20, 2018

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 2017-00874 NC
Surgical Critical Care Physician 2086S0102X MD60848138 WA
Surgery Physician 208600000X MD60848138 WA Primary

Addresses

Primary practice location

505 NE 87TH Ave Ste 301
Vancouver, WA 98664-1965

Mailing address

PO Box 751069
Charlotte, NC 28275-1069

Other practice location 1

517 Moye Blvd
Greenville, NC 27834-2849
Phone (252) 847-4299

Other identifiers 3

IdentifierTypeStateIssuer
19R6UOtherNCBCBS OF NC
NCY144AOtherNCMEDICARE
1366738312MedicaidNC

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
I20181126002023 WA Practitioner - General Surgery 9234437757 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
University of North Carolina at Chapel Hill School of Medicine, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
PeacehealthGroup PAC ID 8820178288, 245 clinicians

Practice addresses (Care Compare)

505 NE 87TH Ave
Vancouver, WA 98664-1965

8821 NE 5TH St
Vancouver, WA 98664-3200
Phone (360) 514-1900

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Upper gastrointestinal (GI) endoscopy for acid reflux1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2017-00874NCMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Peacehealth Surgery CurrentSince Oct 15, 2018 Accepting new patients
Peacehealth Past Accepting new patients

Locations

505 NE 87th Ave
Ste 301
Vancouver, WA 98664
Phone (360) 514-1854

1115 SE 164th Ave
Dept 364
Vancouver, WA 98683
Phone (360) 735-8100

1115 SE 164th Ave
Dept 358
Vancouver, WA 98683
Phone (360) 729-1253

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

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

NPI Registry JSON

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

{
    "created_epoch": "1309219200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1537401600000",
    "number": "1366738312",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 751069",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282751069"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "505 NE 87TH AVE STE 301",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986641965",
            "telephone_number": "360-514-1854"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "517 Moye Blvd",
            "address_purpose": "LOCATION",
            "city": "Greenville",
            "state": "NC",
            "postal_code": "278342849",
            "country_code": "US",
            "telephone_number": "252-847-4299",
            "fax_number": "252-847-8208",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ZEITHAML",
        "first_name": "BRIAN",
        "middle_name": "JOSEPH",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-06-28",
        "last_updated": "2018-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NC",
            "license": "2017-00874",
            "primary": false
        },
        {
            "code": "2086S0102X",
            "taxonomy_group": "",
            "desc": "Surgery, Surgical Critical Care",
            "state": "WA",
            "license": "MD60848138",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "WA",
            "license": "MD60848138",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF NC",
            "identifier": "19R6U",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "NCY144A",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1366738312",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Vancouver, WA

Sources for this page

Verify at the official NPI Registry.