Michael Ray Nielson, D.O.
Individual provider Active NPI Family Medicine Physician · Monticello, UT
NPI 1700225679 · NPPES record last updated Nov 1, 2016
Key facts
- NPI
- 1700225679
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 9551857-1204 (UT)
- Practice address
- 380 W. 100 North
Monticello, UT 84535 - Phone
- (435) 587-2116
- NPI assigned
- Jun 24, 2013
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 6
Hospital & facility affiliations 14
Medicare Care Compare profile
- 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 Hospital
Practice addresses (Care Compare)
380 W 100
Monticello, UT 84535-0308
Phone (435) 587-2116
Hospital & facility affiliations
- Zion'S Way Home Health
- Zion'S Way Hospice
- San Juan Hospital
- Southwest Memorial Hospital
- Moab Regional Hospital
- Blue Mountain Hospital
- Mercy Regional Medical Center
- San Juan Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in UT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160622000080 | UT | Practitioner - Osteopathic Manipulative Medicine | 2264735455 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9551857-1204 | UT | MD | Family Medicine Physician |
| 0052 | SD | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | 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 | 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
- https://fhir-myrecord.cerner.com/r4/d2bc3d5a-3c39-4553-86b1-b3aa0a5429a7/
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 9551857-1204 | UT | Yes |
Addresses
Primary practice location
380 W. 100 North
Monticello, UT 84535
Mailing address
380 W. 100 North
Monticello, UT 84535
Phone (435) 587-2116
Other providers in Monticello, UT
- Allie Maughan
- Thomas Rhett Maughan
- Daniel C Mower
- Francesca R. Nichols
- Benjamin Wolsey Nielson
- Quest Family Services, Inc.
- Paul R. Reay
- Andrew Nima Salim
- San Juan County
- San Juan County
All providers in Monticello, UT · Family Medicine Physician in Utah
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 1, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.