Michael Fong, D.O.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

OP61319260 Issued in WA

Practice address

3240 NE 3Rd Ave
Camas, WA 98607-2408

Phone

(360) 729-8234

Fax

(360) 729-1337

NPI assigned

Apr 3, 2016

Last updated

Sep 7, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

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

Specialty

Dermatology

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

PeacehealthGroup PAC ID 8820178288, 245 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Peacehealth Southwest Medical Cente Hospital, Vancouver, WA, CCN 500050

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

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.

• Peacehealth

  dba PeaceHealth Medical Group

  • Surgery Physician
  • Vancouver, WA
  • NPI 1609061969
  Medicare reassignment Care Compare group NPD
• Cleaver Dermatology PC

  • Dermatology Physician
  • Kirksville, MO
  • NPI 1013452861
  NPD (past)
• Lloyd J. Cleaver, D.O., L.L.C.

  • Dermatology Physician
  • Kirksville, MO
  • NPI 1144366428
  NPD (past)

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

• Peacehealth

  dba PeaceHealth SW Heart & Vascular Center

  • Cardiovascular Disease Physician
  • Vancouver, WA
  • NPI 1003194911

  Hospital

  Care Compare affiliation
• Peacehealth

  dba PeaceHealth Southwest Medical Center

  • General Acute Care Hospital
  • Vancouver, WA
  • NPI 1134178999
  Care Compare affiliation

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

{
    "created_epoch": "1459641600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662508800000",
    "number": "1437512894",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "315 S OSTEOPATHY AVE",
            "city": "KIRKSVILLE",
            "state": "MO",
            "postal_code": "635016401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3240 NE 3RD AVE",
            "city": "CAMAS",
            "state": "WA",
            "postal_code": "986072408",
            "telephone_number": "360-729-8234",
            "fax_number": "360-729-1337"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1316 Country Club Dr",
            "address_purpose": "LOCATION",
            "city": "Kirksville",
            "state": "MO",
            "postal_code": "635015362",
            "country_code": "US",
            "telephone_number": "660-627-7546",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "315 S Osteopathy Ave",
            "address_purpose": "LOCATION",
            "city": "Kirksville",
            "state": "MO",
            "postal_code": "635016401",
            "country_code": "US",
            "telephone_number": "660-785-1000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FONG",
        "first_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-04-03",
        "last_updated": "2022-09-07",
        "certification_date": "2022-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "WA",
            "license": "OP61319260",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200072106",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brodie Macklin Fish, DC
• Tek Fish, DPM
• Flutura Healing
• Focused Hearing
• Megan Marie Folkestad, LMP
• Michelle Ford, RN
• Tracy Jo Foskett
• Christina Lillian Friesen, LMP
• Fusion Natural Health, PLLC
• Christina Leah Gagelmann, LMT

• Dermatology Physician in Camas, WA
• Providers in Camas, WA by specialty
• Dermatology Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2022; 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.