Individual provider Active NPI

Harvey I J Niebulski, M.D.

  • Diagnostic Radiology Physician
  • Seattle, WA
National Provider Identifier
1649323916
Registry record updated Apr 28, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
MD00024731 Issued in WA
Practice address
201 16TH Ave East
Seattle, WA 98112-5260
Phone
(206) 326-3260
Fax
(206) 326-3654
NPI assigned
Jan 19, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X MD00024731 WA Primary

Addresses

Primary practice location

201 16TH Ave East
Seattle, WA 98112-5260

Mailing address

201 16TH Ave E
Seattle, WA 98112-5226
Phone (206) 326-3000

Other identifiers 1

IdentifierTypeStateIssuer
8108953MedicaidWA

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwa.kp.org:14430/Interconnect-CE-PRD/wcf/epic.community.hie/xcpdrespondinggatewaysync Health Information Exchange (HIE)

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080206000222 WA Practitioner - Diagnostic RadiologyPractitioner - Radiation Oncology 7214010875 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
University of Rochester School of Medicine and Dentistry, 1981
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Kaiser Foundation Health Plan of WashingtonGroup PAC ID 9032022579, 1,519 clinicians

Practice addresses (Care Compare)

11511 NE 10TH St
Bellevue, WA 98004-8578
Phone (425) 502-3000

Hospital & facility affiliations

  • Kaiser Permanente Central Hospital Hospital, Seattle, WA, CCN 500052

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD00024731WAMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Kaiser Foundation Health Plan of Washington CurrentSince May 1, 2007 Accepting new patients
Kaiser Foundation Health Plan of Washington CurrentSince May 1, 2007 Accepting new patients

Locations

11511 NE 10th St
Hunts Point, WA 98004
Phone (425) 502-3000

14701 179th Ave SE
Monroe, WA 98272
Phone (360) 794-1409

3030 Limited Ln NW
Olympia, WA 98502
Phone (360) 352-6000

19379 7th Ave NE
Poulsbo, WA 98370
Phone (360) 394-1000

200 15th Ave E
Seattle, WA 98112
Phone (206) 326-4530

201 16th Ave E
Seattle, WA 98112
Phone (206) 326-4545

9505 S Steele St
Tacoma, WA 98444
Phone (253) 597-6800

5821 S Sprague Ct
Tacoma, WA 98409
Phone (253) 396-4200

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.

Hospital & facility affiliations 3

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

NPI Registry JSON

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

{
    "created_epoch": "1169164800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1619568000000",
    "number": "1649323916",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 16TH AVE E",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981125226",
            "telephone_number": "206-326-3000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 16TH AVE EAST",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981125260",
            "telephone_number": "206-326-3260",
            "fax_number": "206-326-3654"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NIEBULSKI",
        "first_name": "HARVEY",
        "middle_name": "I J",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-19",
        "last_updated": "2021-04-28",
        "certification_date": "2021-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "WA",
            "license": "MD00024731",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8108953",
            "state": "WA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwa.kp.org:14430/Interconnect-CE-PRD/wcf/epic.community.hie/xcpdrespondinggatewaysync",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "201 16TH AVE EAST",
            "city": "SEATTLE",
            "state": "WA",
            "country_code": "US",
            "postal_code": "981125260",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Seattle, WA

Sources for this page

Verify at the official NPI Registry.