Active NPI
Sean T Nielson, PA-C, MPAS
- Medical Physician Assistant
- Tacoma, WA
National Provider Identifier
1922164953
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- PA-60561046
- Practice address
- Madigan Army Medical Center 9040 a Jackson Ave
Tacoma, WA 98431-4334 - Phone
- (253) 968-6115
- NPI assigned
- Dec 27, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | MILITARY | ||
| Medical Physician Assistant | 363AM0700X | PA-60561046 | WA | Primary |
Addresses
Primary practice location
Madigan Army Medical Center 9040 a Jackson Ave
Tacoma, WA 98431-4334
Mailing address
Madigan Army Medical Center 9040 a Jackson Ave
Tacoma, WA 98431-0001
Other practice location 1
4508 Ruddell Rd SE
Lacey, WA 98503-4334
Phone (253) 970-3382
Other practice location 2
Madigan Army Medical Center 9040A Fitzsimmons Dr
Tacoma, WA 98431-4334
Phone (253) 968-6115
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PA60561046 | Other | WA | STATE PHYSICIAN ASSISTANT LICENSE |
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA-60561046 | WA | MD | Medical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167177600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1554768000000",
"number": "1922164953",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "MADIGAN ARMY MEDICAL CENTER 9040 A JACKSON AVE",
"city": "TACOMA",
"state": "WA",
"postal_code": "984310001"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "MADIGAN ARMY MEDICAL CENTER 9040 A JACKSON AVE",
"city": "TACOMA",
"state": "WA",
"postal_code": "984314334",
"telephone_number": "253-968-6115"
}
],
"practiceLocations": [
{
"address_1": "4508 Ruddell Rd SE",
"address_purpose": "LOCATION",
"city": "Lacey",
"state": "WA",
"postal_code": "985034334",
"country_code": "US",
"telephone_number": "253-970-3382",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "Madigan Army Medical Center 9040A Fitzsimmons Dr",
"address_purpose": "LOCATION",
"city": "Tacoma",
"state": "WA",
"postal_code": "984314334",
"country_code": "US",
"telephone_number": "253-968-6115",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "NIELSON",
"first_name": "SEAN",
"middle_name": "T",
"name_prefix": "Mr.",
"credential": "PA-C, MPAS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-12-27",
"last_updated": "2019-04-09",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": null,
"license": "MILITARY",
"primary": false
},
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "WA",
"license": "PA-60561046",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE PHYSICIAN ASSISTANT LICENSE",
"identifier": "PA60561046",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tacoma, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.