Mark Dale Nellermoe, D.P.M.

Primary specialty

Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X

License

PO00000507 Issued in WA

Practice address

3929 Bridgeport Way W Ste 308
University Place, WA 98466-4455

Phone

(253) 627-4181

Fax

(253) 272-5922

NPI assigned

Oct 12, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 5

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: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Podiatry

Education

Other, 1981

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

75 of 100Reported as group

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: nellermoedpm@faasa-wa.direct.office.nextgen.com

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.

• Mark D Nellermoe Professional Service Corporation

  • Podiatrist
  • University Place, WA
  • NPI 1194145094
  Medicare reassignment NPD Authorized official
• Fasa Family Wellness, PLLC

  • Podiatrist
  • Tumwater, WA
  • NPI 1790181899

  Foot & Ankle Surgery

  Medicare reassignment NPD
• Fasa Family Wellness PLLC

  • Foot & Ankle Surgery Podiatrist
  • Ellensburg, WA
  • NPI 1992513840
  NPD
• Fasa Family Wellness, PLLC

  • Ambulatory Surgical Clinic/Center
  • Tumwater, WA
  • NPI 1255351714
  NPD

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

{
    "created_epoch": "1160611200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1310342400000",
    "number": "1386733541",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3929 BRIDGEPORT WAY W STE 308",
            "city": "UNIVERSITY PLACE",
            "state": "WA",
            "postal_code": "984664455",
            "telephone_number": "253-627-4181",
            "fax_number": "253-272-5922"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3929 BRIDGEPORT WAY W STE 308",
            "city": "UNIVERSITY PLACE",
            "state": "WA",
            "postal_code": "984664455",
            "telephone_number": "253-627-4181",
            "fax_number": "253-272-5922"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NELLERMOE",
        "first_name": "MARK",
        "middle_name": "DALE",
        "name_prefix": "Dr.",
        "credential": "D.P.M.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-12",
        "last_updated": "2011-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "WA",
            "license": "PO00000507",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID",
            "identifier": "GAB02027",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1102375",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE ID",
            "identifier": "990007694",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPARTMENT OF LABOR & IND",
            "identifier": "0039635",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI #",
            "identifier": "1386733541",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Foot & Ankle Surgery Podiatrist in University Place, WA
• Providers in University Place, WA by specialty
• Foot & Ankle Surgery Podiatrist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2011; 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.