NPIMap

Individual provider Active NPI

Nels Davis Carroll

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Thousand Oaks, CA
National Provider Identifier
1396122099
Registry record updated Feb 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianTaxonomy code 208G00000X
License
A192800 Issued in CA
Practice address
227 W Janss Rd Ste 340
Thousand Oaks, CA 91360-1879
Phone
(805) 852-9100
NPI assigned
May 1, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 22, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician 208G00000X MD61172512 WA
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician 208G00000X A192800 CA Primary

Addresses

Primary practice location

227 W Janss Rd Ste 340
Thousand Oaks, CA 91360-1879

Mailing address

PO Box 743111
Atlanta, GA 30374-3111

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA, CA2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20210920003145 WA Practitioner - Cardiac Surgery 9638462344 Reassigns benefits to 2 organizations
I20240509001128 CA Practitioner - Thoracic SurgeryPractitioner - Cardiac Surgery 9638462344 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Thoracic SurgeryAlso: Cardiac Surgery
Education
Temple University School of Medicine, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
El Camino Health Medical Network LLCGroup PAC ID 6103115183, 202 clinicians

Practice addresses (Care Compare)

2490 Hospital Dr
Mountain View, CA 94040-4117
Phone (650) 962-4321

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Coronary artery bypass graft (CABG)21

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A192800CAMDThoracic Surgery (Cardiothoracic Vascular Surgery) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Health & Services Washington Current Accepting new patients
Providence Health & Services Washington CurrentSince Aug 23, 2021 Accepting new patients
El Camino Health Medical Network, LLC CurrentSince Jan 5, 2026 Accepting new patients
Providence Health & Services Washington CurrentSince Aug 23, 2021 Accepting new patients
El Camino Health Medical Group Past Accepting new patients

Locations

815 Pollard Rd
Los Gatos, CA 95032
Phone (408) 378-6131

2490 Hospital Dr
Ste 210
Mountain View, CA 94040
Phone (650) 962-4321

525 Lilly Rd NE
Olympia, WA 98506
Phone (360) 413-8550

525 Lilly Rd NE
Ste 200
Olympia, WA 98506
Phone (360) 493-4510

413 Lilly Rd NE
Olympia, WA 98506
Phone (360) 491-9480

747 Broadway
Seattle, WA 98122
Phone (360) 658-2488

Interoperability endpoints

  • Direct secure messaging: ncarroll1293755@direct.uclahealth.org
  • Direct secure messaging: ncarroll729588@direct.sw.org
  • Direct secure messaging: nels.carroll@hca3.eclinicaldirectplus.com

Organizations & group practices 5

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.

Hospital & facility affiliations 5

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": "1430438400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708560000000",
    "number": "1396122099",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 743111",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303743111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "227 W JANSS RD STE 340",
            "city": "THOUSAND OAKS",
            "state": "CA",
            "postal_code": "913601879",
            "telephone_number": "805-852-9100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARROLL",
        "first_name": "NELS",
        "middle_name": "DAVIS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-05-01",
        "last_updated": "2024-02-22",
        "certification_date": "2024-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "WA",
            "license": "MD61172512",
            "primary": false
        },
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "CA",
            "license": "A192800",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Thousand Oaks, CA

Sources for this page

Verify at the official NPI Registry.