Active NPI
Michael Steven Elliott, SOIDC
- Independent Duty Corpsman
- Camp Pendleton, CA
National Provider Identifier
1578829826
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Independent Duty Corpsman
- License
- 10126925ME
- Practice address
- 1St Marine Special Operations BTN.
Box 555341
Camp Pendleton, CA 92055-5341 - Phone
- (760) 725-5298
- NPI assigned
- Apr 11, 2012
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Independent Duty Corpsman | 1710I1002X | 10126925ME | NC | Primary |
Addresses
Primary practice location
1St Marine Special Operations BTN.
Box 555341
Camp Pendleton, CA 92055-5341
Mailing address
1St Marine Special Operations BTN.
Camp Pendleton, Ca 92055
Apo, AP 92055
Phone (509) 780-1453
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10126925ME | NC | MD | Independent Duty Corpsman |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1334102400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1334102400000",
"number": "1578829826",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "MIL",
"address_1": "1ST MARINE SPECIAL OPERATIONS BTN.",
"address_2": "CAMP PENDLETON, CA 92055",
"city": "APO",
"state": "AP",
"postal_code": "92055",
"telephone_number": "509-780-1453"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1ST MARINE SPECIAL OPERATIONS BTN.",
"address_2": "BOX 555341",
"city": "CAMP PENDLETON",
"state": "CA",
"postal_code": "920555341",
"telephone_number": "760-725-5298"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLIOTT",
"first_name": "MICHAEL",
"middle_name": "STEVEN",
"credential": "SOIDC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-04-11",
"last_updated": "2012-04-11",
"status": "A"
},
"taxonomies": [
{
"code": "1710I1002X",
"taxonomy_group": "",
"desc": "Military Health Care Provider, Independent Duty Corpsman",
"state": "NC",
"license": "10126925ME",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Camp Pendleton, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.