Nicolette Ileana Bembenek, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

MD60489495 Issued in WA

Practice address

700 NE 87TH Ave
Vancouver, WA 98664-1913

Phone

(360) 882-2778

Fax

(360) 604-1693

NPI assigned

Aug 21, 2012

Last updated

Jul 28, 2015By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Nov 29, 2021 through Nov 29, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Interoperability endpoints

• Direct secure messaging: nicolette.bembenek@436756495925252.direct.elationemr.com

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

{
    "created_epoch": "1345507200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1438041600000",
    "number": "1396093498",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 NE 87TH AVE",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986641913",
            "telephone_number": "360-882-2778",
            "fax_number": "360-604-1693"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 NE 87TH AVE",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986641913",
            "telephone_number": "360-882-2778",
            "fax_number": "360-604-1693"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BEMBENEK",
        "first_name": "NICOLETTE",
        "middle_name": "ILEANA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-08-21",
        "last_updated": "2015-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "MD60489495",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Oscar Daniel Beltran Leyva
• Brenda Beltran, MS
• Heather Belts, LMHCA
• McKenna Lee Belzer, M.D.
• Bembenek Travel Health Washington, PC (Passport Health)
• Ben Huckett Health Services PC (Strong Mind Psychiatry)
• Matthew James Benage, MD
• Ryan Elizabeth Bender, LISWA
• Walter Charles Bender, MS LMHC
• Cari Bendersky

• Family Medicine Physician in Vancouver, WA
• Providers in Vancouver, WA by specialty
• Family Medicine Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2015; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.