Sima Gopal Mistry, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

60403767 Issued in WA

Practice address

11603 State Ave Ste G
Providence Medical Group Marysville Clinic
Marysville, WA 98271-8465

Phone

(360) 658-6800

Fax

(360) 658-6819

NPI assigned

Apr 9, 2009

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Providence Health & Services- Washington

  • General Practice Physician
  • Everett, WA
  • NPI 1124270715
  Medicare reassignment NPD
• South Sound Inpatient Physicians PLLC

  • Internal Medicine Physician
  • Vancouver, WA
  • NPI 1023285756
  Medicare reassignment NPD
• Providence Health & Services - Washington

  • General Practice Physician
  • Everett, WA
  • NPI 1013169507

  Pediatrics

  NPD

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

{
    "created_epoch": "1239235200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1424217600000",
    "number": "1760625552",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3360",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972083360",
            "telephone_number": "866-366-2983"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11603 STATE AVE STE G",
            "address_2": "PROVIDENCE MEDICAL GROUP MARYSVILLE CLINIC",
            "city": "MARYSVILLE",
            "state": "WA",
            "postal_code": "982718465",
            "telephone_number": "360-658-6800",
            "fax_number": "360-658-6819"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MISTRY",
        "first_name": "SIMA",
        "middle_name": "GOPAL",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-04-09",
        "last_updated": "2015-02-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "WA",
            "license": "60403767",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WA",
            "license": "60403767",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1926710",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WSL",
            "identifier": "MD60403767",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michael Giovine DMD PLLC
• Megan Elaine Miles
• Claire Burke Mills, DDS
• Christopher Mina, M.D.
• Stacey Reiko Leong Minson, DOT
• Esther Giles Mitema, RN
• Kaitlin Rose Mizell
• Bianca R Mocanu
• Elizabeth Moe, PHD
• Umar Sohail Mohammed, MD

• Pediatrics Physician in Marysville, WA
• Providers in Marysville, WA by specialty
• Pediatrics Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.