NPIMap

Individual provider Active NPI

Nicholas F Carulli, MD

  • Internal Medicine Physician
  • Vancouver, WA
National Provider Identifier
1871682237
Registry record updated Nov 17, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD00037171 Issued in WA
Practice address
304 N Lieser Rd
Vancouver, WA 98664-2115
Phone
(360) 694-7565
Fax
(360) 906-0871
NPI assigned
Oct 12, 2006
Last updated
Nov 17, 2009By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 17, 2009

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD00037171 WA Primary
Internal Medicine Physician 207R00000X MD16072 OR

Addresses

Primary practice location

304 N Lieser Rd
Vancouver, WA 98664-2115

Mailing address

PO Box 8945
Vancouver, WA 98668-8945
Phone (360) 694-7565

Other identifiers 1

IdentifierTypeStateIssuer
1107689MedicaidWA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060103000277 WA Practitioner - Internal Medicine 4688666134 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Oregon Health Sciences University School of Medicine, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

2115 SE 192ND Ave
Suite 110
Camas, WA 98607-7444
Phone (360) 210-7166

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions25

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD16072ORMDInternal Medicine Physician
MD00037171WAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Nicholas F. Carulli MD, PC Internal Medicine CurrentSince May 17, 2005 Accepting new patients

Locations

2115 SE 192nd Ave
Ste 110
Camas, WA 98607
Phone (360) 210-7166

304 N Lieser Rd
Vancouver, WA 98664
Phone (360) 694-7565

Interoperability endpoints

  • Direct secure messaging: carullimedicalclinic.nicholascarulli@147761.advancedmd-direct.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 10

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": "1160611200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1258416000000",
    "number": "1871682237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8945",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986688945",
            "telephone_number": "360-694-7565",
            "fax_number": "360-906-0871"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "304 N LIESER RD",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986642115",
            "telephone_number": "360-694-7565",
            "fax_number": "360-906-0871"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARULLI",
        "first_name": "NICHOLAS",
        "middle_name": "F",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-12",
        "last_updated": "2009-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WA",
            "license": "MD00037171",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OR",
            "license": "MD16072",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1107689",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Vancouver, WA

Sources for this page

Verify at the official NPI Registry.