Individual provider Active NPI

Robert W. Nelson, M.D.

  • Family Medicine Physician
  • Iron Mountain, MI
National Provider Identifier
1598743882
Registry record updated Oct 8, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
4301117312 Issued in MI
Practice address
440 Woodward Ave
Iron Mountain, MI 49801-4631
Phone
(906) 776-9040
Fax
(906) 774-5950
NPI assigned
Jan 6, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 8, 2020

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 4301117312 MI Primary
Family Medicine Physician 207Q00000X 65037 GA

Addresses

Primary practice location

440 Woodward Ave
Iron Mountain, MI 49801-4631

Mailing address

PO Box 22487
Green Bay, WI 54305-2487
Phone (920) 445-7222

Other practice location 1

108 Prominence Ct
Dawsonville, GA 30534-6339
Phone (706) 216-3238

Other identifiers 2

IdentifierTypeStateIssuer
ABIM-MOCOtherAMERICAN BOARD OF FAMILY MEDICINE
291645419AMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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
I20050915000522 OH Practitioner - Family Practice 2264405232

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Ohio State University College of Medicine, 1985
Medicare assignment
May accept Medicare assignment
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

2261 Market St
San Francisco, CA 94114-1612

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
65037GAMDFamily Medicine Physician
4301117312MIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
P.R. Care, LTD Past Accepting new patients
Renown Urgent Care LLC Family Medicine Past Accepting new patients

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": "1136505600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602115200000",
    "number": "1598743882",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 22487",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543052487",
            "telephone_number": "920-445-7222",
            "fax_number": "920-445-7289"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "440 WOODWARD AVE",
            "city": "IRON MOUNTAIN",
            "state": "MI",
            "postal_code": "498014631",
            "telephone_number": "906-776-9040",
            "fax_number": "906-774-5950"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "108 Prominence Ct",
            "address_purpose": "LOCATION",
            "city": "Dawsonville",
            "state": "GA",
            "postal_code": "305346339",
            "country_code": "US",
            "telephone_number": "706-216-3238",
            "fax_number": "770-219-9141",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NELSON",
        "first_name": "ROBERT",
        "middle_name": "W.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-06",
        "last_updated": "2020-10-08",
        "certification_date": "2020-10-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301117312",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "65037",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERICAN BOARD OF FAMILY MEDICINE",
            "identifier": "ABIM-MOC",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "291645419A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Iron Mountain, MI

Sources for this page

Verify at the official NPI Registry.