Individual provider Active NPI

David John Carlson, DO

  • Family Medicine Physician
  • Lakewood, WA
National Provider Identifier
1730113192
Registry record updated Nov 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
OP60758010 Issued in WA
Practice address
7424 Bridgeport Way W Ste 201
Lakewood, WA 98499-8134
Phone
(253) 240-2110
Fax
(253) 240-2111
NPI assigned
Jul 10, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 20, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X DO.000037 LA
Family Medicine Physician 207Q00000X OP60758010 WA Primary

Addresses

Primary practice location

7424 Bridgeport Way W Ste 201
Lakewood, WA 98499-8134

Mailing address

PO Box 34703
Seattle, WA 98124-1703

Other identifiers 1

IdentifierTypeStateIssuer
2254083MedicaidWA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230807000553 WA Practitioner - Family Practice 1850517939 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
DO.000037LAMDFamily Medicine Physician
OP60758010WAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Sea Mar Community Health Centers Family Medicine CurrentSince Jul 3, 2023 Accepting new patients
Sea Mar Community Health Centers CurrentSince Jul 3, 2023 Accepting new patients
Sea Mar Community Health Centers Family Medicine Current Accepting new patients
Franciscan Medical Group Family Medicine CurrentSince Sep 16, 2024 Accepting new patients
Franciscan Medical Group CurrentSince Sep 16, 2024 Accepting new patients
Windber Hospital, Inc. Past Accepting new patients
Summit Physician Services Family Medicine Past Accepting new patients

Locations

1400 N Laventure Rd
Mount Vernon, WA 98273
Phone (360) 428-4075

1812 S J St
Ste 120
Tacoma, WA 98405
Phone (253) 428-2200

7424 Bridgeport Way W
Tacoma, WA 98499
Phone (253) 581-2111

7424 Bridgeport Way W
Ste 201
Tacoma, WA 98499
Phone (253) 240-2110

7210 40th St W
Ste 100
University Place, WA 98466
Phone (253) 564-0170

Organizations & group practices 7

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": "1152489600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1700438400000",
    "number": "1730113192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 34703",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981241703"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7424 BRIDGEPORT WAY W STE 201",
            "city": "LAKEWOOD",
            "state": "WA",
            "postal_code": "984998134",
            "telephone_number": "253-240-2110",
            "fax_number": "253-240-2111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARLSON",
        "first_name": "DAVID",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-10",
        "last_updated": "2023-11-20",
        "certification_date": "2023-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "LA",
            "license": "DO.000037",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "OP60758010",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2254083",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lakewood, WA

Sources for this page

Verify at the official NPI Registry.