Individual provider Active NPI

Michelle Thuy Tien Nguyen, MD

  • Sports Medicine (Family Medicine) Physician
  • Indianapolis, IN
National Provider Identifier
1801358965
Registry record updated Dec 11, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X
License
MD218149 Issued in OR
Practice address
1520 N Senate Ave
Indianapolis, IN 46202-2213
Phone
(317) 962-8893
NPI assigned
Apr 5, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 11, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Sports Medicine (Family Medicine) Physician 207QS0010X MD218149 OR Primary

Addresses

Primary practice location

1520 N Senate Ave
Indianapolis, IN 46202-2213

Mailing address

1520 N Senate Ave
Indianapolis, IN 46202-2213
Phone (317) 962-8893

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
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
I20231128002675 OR Practitioner - Sports Medicine 6204160849 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Sports Medicine
Education
Indiana University School of Medicine, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Legacy Clinics LLCGroup PAC ID 0244144004, 714 clinicians

Practice addresses (Care Compare)

1960 NW 167TH PL
Suite 200
Beaverton, OR 97006-4804
Phone (503) 413-4488

Hospital & facility affiliations

  • Legacy Good Samaritan Medical Center Hospital, Portland, OR, CCN 380017
  • Legacy Emanuel Medical Center Hospital, Portland, OR, CCN 380007

Merit-based Incentive Payment System (MIPS)

Final score
94.62 of 100Reported as apm
Quality
77.21
Promoting interoperability
99.06
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Legacy Clinics LLC CurrentSince Nov 13, 2023 Accepting new patients

Locations

1960 NW 167th Pl
Ste 200
Beaverton, OR 97006
Phone (503) 413-4488

1130 NW 22nd Ave
Ste 220
Portland, OR 97210
Phone (503) 413-4134

450 N Graham St
Portland, OR 97227
Phone (503) 413-4161

1919 NW Lovejoy St
Portland, OR 97209
Phone (503) 415-5600

Organizations & group practices 1

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.

Hospital & facility affiliations 6

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

NPI Registry JSON

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

{
    "created_epoch": "1554422400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702252800000",
    "number": "1801358965",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1520 N SENATE AVE",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462022213",
            "telephone_number": "317-962-8893"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1520 N SENATE AVE",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462022213",
            "telephone_number": "317-962-8893"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NGUYEN",
        "first_name": "MICHELLE",
        "middle_name": "THUY TIEN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-04-05",
        "last_updated": "2023-12-11",
        "certification_date": "2023-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "OR",
            "license": "MD218149",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Indianapolis, IN

Sources for this page

Verify at the official NPI Registry.