Individual provider Active NPI

Mia K. Michalak, ARNP

  • Family Nurse Practitioner
  • Seattle, WA
National Provider Identifier
1669838199
Registry record updated Jan 2, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
AP60630739 Issued in WA
Practice address
9245 Rainier Ave S
Seattle, WA 98118-5569
Phone
(206) 548-3114
Fax
(206) 762-6355
NPI assigned
Jan 13, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 2, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X AP60630739 WA Primary

Addresses

Primary practice location

9245 Rainier Ave S
Seattle, WA 98118-5569

Mailing address

PO Box 3835
Seattle, WA 98124-3835
Phone (206) 548-3114

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA, OR, OH, CO, NC5 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 5

Enrollment IDStateProvider typePAC IDDetails
I20160602001507 WA Practitioner - Nurse Practitioner 3072803303 Reassigns benefits to 2 organizations
I20201217001134 OR Practitioner - Nurse Practitioner 3072803303 Reassigns benefits to 1 organization
I20220301001288 OH Practitioner - Nurse Practitioner 3072803303 Reassigns benefits to 1 organization
I20230223001434 CO Practitioner - Nurse Practitioner 3072803303 Reassigns benefits to 1 organization
I20240918002983 NC Practitioner - Nurse Practitioner 3072803303 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Boulder Care Provider Group PAGroup PAC ID 6901217447, 115 clinicians

Practice addresses (Care Compare)

106 Langtree Village Dr
Suite 301
Mooresville, NC 28117-7594
Phone (888) 288-4715

111 SW Naito Pkwy
Suite 200
Portland, OR 97204-3512
Phone (503) 563-7370

20046 Walker Rd
Suite 7
Shaker Heights, OH 44122-3645
Phone (503) 208-5061

915 Broadway St
Suite 137
Vancouver, WA 98660-3278
Phone (503) 208-5061

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
AP60630739WAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Boulder Care Provider Group PA CurrentSince Nov 15, 2020 Accepting new patients
Neighborcare Health Current Accepting new patients
Neighborcare Health CurrentSince Jan 7, 2019 Accepting new patients
Neighborcare Health Current Accepting new patients
Neighborcare Health CurrentSince Jan 7, 2019 Accepting new patients
Peninsula Community Health Services Past Accepting new patients

Locations

1109 Oak Park Dr
Ste 125
Fort Collins, CO 80525

106 Langtree Village Dr
Ste 301
Mooresville, NC 28117
Phone (704) 457-1368

20046 Walker Rd
Ste 7
Shaker Heights, OH 44122
Phone (503) 208-5061

208 SW Harvey Milk St
Ste 200
Portland, OR 97204
Phone (503) 208-5061

111 SW Naito Pkwy
Ste 200
Portland, OR 97204
Phone (503) 208-5061

4400 37th Ave S
Seattle, WA 98118
Phone (206) 296-4650

1629 N 45th St
Seattle, WA 98103
Phone (206) 633-3350

12721 30th Ave NE
Ste 101
Seattle, WA 98125
Phone (206) 417-0326

9245 Rainier Ave S
Seattle, WA 98118
Phone (206) 461-6981

6020 35th Ave SW
Seattle, WA 98126
Phone (206) 461-6950

915 Broadway St
Ste 137
Vancouver, WA 98660
Phone (503) 208-5061

Organizations & group practices 6

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": "1452643200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1546387200000",
    "number": "1669838199",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3835",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981243835",
            "telephone_number": "206-548-3114",
            "fax_number": "206-762-6355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9245 RAINIER AVE S",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981185569",
            "telephone_number": "206-548-3114",
            "fax_number": "206-762-6355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MICHALAK",
        "first_name": "MIA",
        "middle_name": "K.",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-01-13",
        "last_updated": "2019-01-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WA",
            "license": "AP60630739",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Seattle, WA

Sources for this page

Verify at the official NPI Registry.