Individual provider Active NPI

Nicholas Thunder, MSW MHP

  • Clinical Social Worker
  • Everett, WA
National Provider Identifier
1811304553
Registry record updated Jan 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
LW61431521 Issued in WA
Practice address
3322 Broadway
Everett, WA 98201-4425
Phone
(425) 349-8359
Fax
(425) 349-8348
NPI assigned
Jul 15, 2014
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 18, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X CG60510613 WA
Clinical Social Worker 1041C0700X LW61431521 WA Primary

Addresses

Primary practice location

3322 Broadway
Everett, WA 98201-4425

Mailing address

4526 Federal Ave
Everett, WA 98203-2132
Phone (425) 349-6200

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: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240227004023 WA Practitioner - Clinical Social Worker 5597100784 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pacmed ClinicsGroup PAC ID 2466350657, 211 clinicians

Practice addresses (Care Compare)

12910 Totem Lake Blvd NE
Suite 101
Kirkland, WA 98034-2901
Phone (425) 814-5000

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
CG60510613WAMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Pacmed Clinics CurrentSince Feb 26, 2024 Accepting new patients
Pacmed Clinics Current Accepting new patients

Locations

12910 Totem Lake Blvd NE
Ste 101
Kirkland, WA 98034
Phone (425) 814-5000

220 15th Ave SE
Puyallup, WA 98372
Phone (253) 435-3400

1200 12th Ave S
Seattle, WA 98144
Phone (206) 326-2400

1101 Madison St
Ste 301
Seattle, WA 98104
Phone (206) 505-1101

Organizations & group practices 2

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": "1405382400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705536000000",
    "number": "1811304553",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4526 FEDERAL AVE",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982032132",
            "telephone_number": "425-349-6200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3322 BROADWAY",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982014425",
            "telephone_number": "425-349-8359",
            "fax_number": "425-349-8348"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THUNDER",
        "first_name": "NICHOLAS",
        "credential": "MSW MHP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-07-15",
        "last_updated": "2024-01-18",
        "certification_date": "2024-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "WA",
            "license": "CG60510613",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WA",
            "license": "LW61431521",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Everett, WA

Sources for this page

Verify at the official NPI Registry.