Active NPI
Nicole Prevo Kageyama, M.D.
- Dermatology Physician
- Renton, WA
National Provider Identifier
1407858665
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- License
- MD00046078
- Practice address
- 1412 SW 43Rd St Ste 205
Renton, WA 98057-4803 - Phone
- (425) 264-0660
- Fax
- (425) 264-0601
- NPI assigned
- Jun 1, 2005
- Last updated
- Sep 7, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | MD00046078 | WA | Primary |
| Dermatopathology Physician | 207ND0900X | MD00046078 | WA |
Addresses
Primary practice location
1412 SW 43Rd St Ste 205
Renton, WA 98057-4803
Mailing address
1200 112TH Ave NE
Suite C-187
Bellevue, WA 98007
Phone (425) 457-7900
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P00301940 | Other | WA | RAILROAD MEDICARE |
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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Dermatology
- Education
- University of Hawaii John a. Burns School of Medicine, 1998
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
1200 112TH Ave NE
C187
Bellevue, WA 98004-3732
Merit-based Incentive Payment System (MIPS)
- Final score
- 100 of 100
- Promoting interoperability
- 100
- Improvement activities
- 40
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Melanoma (skin cancer) excision | 14 |
| Removal of skin lesions | 1065 |
| Removal or shaving of skin growth | 1-10 |
| Skin biopsy | 164 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD00046078 | WA | MD | Dermatopathology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| North Pacific Dermatology Services, LLC | Dermatology | Past | Accepting new patients |
| Angela G Bowers, MD PA | Past | Accepting new patients |
Organizations & group practices 3
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.
-
- Ambulatory Surgical Clinic/Center
- Renton, WA
- NPI 1881845907
-
- Dermatology Physician
- Renton, WA
- NPI 1790973436
-
- Specialist
- Southlake, TX
- NPI 1942233895
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1117584000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1504742400000",
"number": "1407858665",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1200 112TH AVE NE",
"address_2": "SUITE C-187",
"city": "BELLEVUE",
"state": "WA",
"postal_code": "98007",
"telephone_number": "425-457-7900",
"fax_number": "425-457-7499"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1412 SW 43RD ST STE 205",
"city": "RENTON",
"state": "WA",
"postal_code": "980574803",
"telephone_number": "425-264-0660",
"fax_number": "425-264-0601"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KAGEYAMA",
"first_name": "NICOLE",
"middle_name": "PREVO",
"name_prefix": "Mrs.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-06-01",
"last_updated": "2017-09-07",
"status": "A"
},
"taxonomies": [
{
"code": "207N00000X",
"taxonomy_group": "",
"desc": "Dermatology",
"state": "WA",
"license": "MD00046078",
"primary": true
},
{
"code": "207ND0900X",
"taxonomy_group": "",
"desc": "Dermatology, Dermatopathology",
"state": "WA",
"license": "MD00046078",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "P00301940",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Renton, WA
- Marshall Just, DC
- Justin Courtney DDS PS
- Justin Courtney PLLC (Washington Sleep Solutions)
- Katarzyna Kabat, MD
- Larry J Kadeg, MD
- Nobuyoshi Kageyama, M. D.
- Borys B Kagramanov, LMP
- Kaiser Foundation Health Plan of Washington (Renton Medical Center)
- Kaiser Foundation Health Plan of Washington
- Kaiser Foundation Health Plan of Washington
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2017; 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.