NPIMap

Individual provider Active NPI

John Raymond Nelson III, M.D.

  • Internal Medicine Physician
  • Bellevue, WA
National Provider Identifier
1831151794
Registry record updated Jul 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD00038560 Issued in WA
Practice address
1035 116TH Ave NE
Hospitalist Dept.
Bellevue, WA 98004-4604
Phone
(425) 688-5072
Fax
(425) 467-3310
NPI assigned
Apr 5, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD00038560 WA Primary

Addresses

Primary practice location

1035 116TH Ave NE
Hospitalist Dept.
Bellevue, WA 98004-4604

Mailing address

PO Box 3905
Dept. 4204
Seattle, WA 98124-3905
Phone (360) 514-9060

Other identifiers 4

IdentifierTypeStateIssuer
110206087OtherWARAILROAD MEDICARE
8255465MedicaidWA
0141614OtherWAL & I WORKERS COMP.
2807NEOtherWAREGENCE BLUESHIELD RIDER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD00038560WAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Issaquah Obstetrics and Gynecology PLLC Past Accepting new patients
Overlake Medical Clinics, LLC Past Accepting new patients
Hospital Internal Medicine PA Past Accepting new patients

Organizations & group practices 3

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": "1144195200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1831151794",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3905",
            "address_2": "DEPT. 4204",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981243905",
            "telephone_number": "360-514-9060",
            "fax_number": "360-514-9041"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1035 116TH AVE NE",
            "address_2": "HOSPITALIST DEPT.",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980044604",
            "telephone_number": "425-688-5072",
            "fax_number": "425-467-3310"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NELSON",
        "first_name": "JOHN",
        "middle_name": "RAYMOND",
        "name_suffix": "III",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-05",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WA",
            "license": "MD00038560",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "110206087",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8255465",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "L & I WORKERS COMP.",
            "identifier": "0141614",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE BLUESHIELD RIDER",
            "identifier": "2807NE",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bellevue, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.