Active NPI
Mark Roland Nyreen, M.D.
- Surgery Physician
- Federal Way, WA
National Provider Identifier
1669401048
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 23476
- Practice address
- 34509 9TH Ave S Ste 208
Federal Way, WA 98003-8709 - Phone
- (253) 944-3278
- Fax
- (253) 944-4345
- NPI assigned
- Jun 30, 2006
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 23476 | WA | Primary |
Addresses
Primary practice location
34509 9TH Ave S Ste 208
Federal Way, WA 98003-8709
Mailing address
34509 9TH Ave S Ste 208
Federal Way, WA 98003-8709
Phone (253) 944-3278
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0246499 | Other | WA | STATE L&I |
| 0188615 | Other | WA | STATE L&I |
| 0246079 | Other | WA | STATE L&I |
| 0226625 | Other | WA | STATE L&I |
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD23476 | OR | MD | Neurology Physician |
| 23476 | WA | MD | Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pacific Vascular Incorporated | Past | Accepting new patients | |
| Franciscan Medical Group | 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.
-
- Neurological Surgery Physician
- Federal Way, WA
- NPI 1386857530
-
- Physiological Laboratory
- Port Ludlow, WA
- NPI 1336019314
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151625600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1304640000000",
"number": "1669401048",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "34509 9TH AVE S STE 208",
"city": "FEDERAL WAY",
"state": "WA",
"postal_code": "980038709",
"telephone_number": "253-944-3278",
"fax_number": "253-944-4345"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "34509 9TH AVE S STE 208",
"city": "FEDERAL WAY",
"state": "WA",
"postal_code": "980038709",
"telephone_number": "253-944-3278",
"fax_number": "253-944-4345"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NYREEN",
"first_name": "MARK",
"middle_name": "ROLAND",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-30",
"last_updated": "2011-05-06",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "WA",
"license": "23476",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE L&I",
"identifier": "0246499",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE L&I",
"identifier": "0188615",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE L&I",
"identifier": "0246079",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE L&I",
"identifier": "0226625",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Federal Way, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.