NPIMap

Individual provider Active NPI

Allen Millard III, MD

  • Family Medicine Physician
  • Shelton, WA
National Provider Identifier
1669468351
Registry record updated Feb 4, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD00025623 Issued in WA
Practice address
1701 N 13TH St
Shelton, WA 98584-2077
Phone
(360) 426-2653
NPI assigned
Sep 27, 2005
Last updated
Feb 4, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 4, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MD00025623 WA Primary

Addresses

Primary practice location

1701 N 13TH St
Shelton, WA 98584-2077

Mailing address

PO Box 1668
Shelton, WA 98584-5001
Phone (360) 426-2653

Other identifiers 1

IdentifierTypeStateIssuer
8117525MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20081217000700 WA Practitioner - Family Practice 3274695713 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1983
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

2300 Kati CT
Shelton, WA 98584-1926

901 Mountain View Dr
Shelton, WA 98584-4401
Phone (360) 426-1611

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Public Hospital District No 1 of Mason County CurrentSince Oct 12, 2013 Accepting new patients
Public Hospital District No 1 of Mason County Wa CurrentSince Oct 12, 2013 Accepting new patients
Public Hospital District No 1 of Mason County Current Accepting new patients

Locations

1701 N 13th St
Shelton, WA 98584
Phone (360) 426-2653

221 Professional Way
Shelton, WA 98584
Phone (360) 426-0121

237 Professional Way
Shelton, WA 98584
Phone (360) 426-2500

901 Mountain View Dr
Shelton, WA 98584
Phone (360) 426-1611

939 Mountain View Dr
Ste 100
Shelton, WA 98584
Phone (360) 426-2653

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 8

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": "1127779200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612396800000",
    "number": "1669468351",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1668",
            "city": "SHELTON",
            "state": "WA",
            "postal_code": "985845001",
            "telephone_number": "360-426-2653",
            "fax_number": "360-462-2500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1701 N 13TH ST",
            "city": "SHELTON",
            "state": "WA",
            "postal_code": "985842077",
            "telephone_number": "360-426-2653"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MILLARD",
        "first_name": "ALLEN",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-27",
        "last_updated": "2021-02-04",
        "certification_date": "2021-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "MD00025623",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8117525",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Shelton, WA

Sources for this page

Verify at the official NPI Registry.