NPIMap

Individual provider Active NPI

Michael Ray Nielson, D.O.

  • Family Medicine Physician
  • Monticello, UT
National Provider Identifier
1700225679
Registry record updated Nov 1, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
9551857-1204 Issued in UT
Practice address
380 W. 100 North
Monticello, UT 84535
Phone
(435) 587-2116
NPI assigned
Jun 24, 2013
Last updated
Nov 1, 2016By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 1, 2016

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 9551857-1204 UT Primary

Addresses

Primary practice location

380 W. 100 North
Monticello, UT 84535

Mailing address

380 W. 100 North
Monticello, UT 84535
Phone (435) 587-2116

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT
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
I20160622000080 UT Practitioner - Osteopathic Manipulative Medicine 2264735455 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Osteopathic Manipulative Medicine
Education
Arizona College of Osteopathic Medicine Mid Western University, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
San Juan County HospitalGroup PAC ID 4486541851, shared by 5 NPIs, 19 clinicians

Practice addresses (Care Compare)

380 W 100
Monticello, UT 84535-0308
Phone (435) 587-2116

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
San Juan County Hospital CurrentSince Apr 19, 2016 Accepting new patients
San Juan County Hospital Family Medicine CurrentSince Apr 19, 2016 Accepting new patients
San Juan County Hospital Family Medicine Current Accepting new patients
San Juan County Hospital Current Accepting new patients
San Juan County Hospital Family Medicine Past Accepting new patients

Locations

735 S 200 W
Ste 3
Blanding, UT 84511
Phone (435) 678-2254

5555 Old Airport Rd
Moab, UT 84532
Phone (435) 419-9210

Interoperability endpoints

  • FHIR API: https://fhir-myrecord.cerner.com/r4/d2bc3d5a-3c39-4553-86b1-b3aa0a5429a7/

Organizations & group practices 5

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 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1372032000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1477958400000",
    "number": "1700225679",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "380 W. 100 NORTH",
            "city": "MONTICELLO",
            "state": "UT",
            "postal_code": "84535",
            "telephone_number": "435-587-2116"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "380 W. 100 NORTH",
            "city": "MONTICELLO",
            "state": "UT",
            "postal_code": "84535",
            "telephone_number": "435-587-2116"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NIELSON",
        "first_name": "MICHAEL",
        "middle_name": "RAY",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-06-24",
        "last_updated": "2016-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "UT",
            "license": "9551857-1204",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Monticello, UT

Sources for this page

Verify at the official NPI Registry.