Active NPI
Gary B Sahlstrom, M.D.
- Diagnostic Radiology Physician
- Vancouver, WA
National Provider Identifier
1902800311
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Diagnostic Radiology Physician
- License
- MD00017398
- Practice address
- 4816A NE Thurston Way
Vancouver, WA 98662 - Phone
- (360) 254-4914
- Fax
- (360) 449-4961
- NPI assigned
- Jun 13, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diagnostic Radiology Physician | 2085R0202X | MD00017398 | WA | Primary |
| Diagnostic Radiology Physician | 2085R0202X | MD11587 | OR | |
| Diagnostic Radiology Physician | 2085R0202X | G30418 | CA |
Addresses
Primary practice location
4816A NE Thurston Way
Vancouver, WA 98662
Mailing address
4201 NE 66TH Ave.
Suite 104
Vancouver, WA 98661
Phone (360) 254-4914
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8239204 | Medicaid | WA |
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
| License | State | Type | Specialty |
|---|---|---|---|
| G30418 | CA | MD | Diagnostic Radiology Physician |
| MD11587 | OR | MD | Diagnostic Radiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Advanced Medical Imaging Center LLC | Diagnostic Radiology | Past | Accepting new patients |
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.
-
- Diagnostic Radiology Physician
- Vancouver, WA
- NPI 1114008737
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1118620800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1347321600000",
"number": "1902800311",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4201 NE 66TH AVE.",
"address_2": "SUITE 104",
"city": "VANCOUVER",
"state": "WA",
"postal_code": "98661",
"telephone_number": "360-254-4914",
"fax_number": "360-449-4961"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4816A NE THURSTON WAY",
"city": "VANCOUVER",
"state": "WA",
"postal_code": "98662",
"telephone_number": "360-254-4914",
"fax_number": "360-449-4961"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SAHLSTROM",
"first_name": "GARY",
"middle_name": "B",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-06-13",
"last_updated": "2012-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "2085R0202X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Radiology",
"state": "WA",
"license": "MD00017398",
"primary": true
},
{
"code": "2085R0202X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Radiology",
"state": "OR",
"license": "MD11587",
"primary": false
},
{
"code": "2085R0202X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Radiology",
"state": "CA",
"license": "G30418",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8239204",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Vancouver, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.