Individual provider Active NPI

Julie Lynn Swanson, MD

  • Family Medicine Physician
  • Las Vegas, NV
National Provider Identifier
1457655482
Registry record updated Sep 15, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
12489 Issued in MT
Practice address
2316 W Charleston Blvd
Las Vegas, NV 89102-2149
Phone
(702) 877-8600
Fax
(702) 667-4651
NPI assigned
Jan 5, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 15, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 12489 MT Primary
Family Medicine Physician 207Q00000X 10701 NV

Addresses

Primary practice location

2316 W Charleston Blvd
Las Vegas, NV 89102-2149

Mailing address

PO Box 15645
Las Vegas, NV 89114-5645
Phone (702) 579-3270

Other identifiers 2

IdentifierTypeStateIssuer
1457655482OtherNVSMA MEDICAID
V111463OtherNVSMA MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV
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

Enrollment IDStateProvider typePAC IDDetails
I20150903002892 NV Practitioner - Family Practice 0648450627 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
12489MTMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southwest Medical Associates, Inc CurrentSince Sep 21, 2015 Accepting new patients
Frances Mahon Deaconess Hospital Past Accepting new patients

Locations

2316 W Charleston Blvd
Las Vegas, NV 89102
Phone (702) 877-8330

2316 W Charleston Blvd
Ste 274
Las Vegas, NV 89102

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1294185600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1442275200000",
    "number": "1457655482",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 15645",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891145645",
            "telephone_number": "702-579-3270",
            "fax_number": "702-667-4651"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2316 W CHARLESTON BLVD",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891022149",
            "telephone_number": "702-877-8600",
            "fax_number": "702-667-4651"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SWANSON",
        "first_name": "JULIE",
        "middle_name": "LYNN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-01-05",
        "last_updated": "2015-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MT",
            "license": "12489",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NV",
            "license": "10701",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SMA MEDICAID",
            "identifier": "1457655482",
            "state": "NV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SMA MEDICARE",
            "identifier": "V111463",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

Verify at the official NPI Registry.