NPIMap

Organization Active NPI

NW Interventional Medicine and Orthopedic Rehab PLLC

  • Medical Physician Assistant
  • Vancouver, WA
National Provider Identifier
1982058814
Registry record updated Apr 18, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
Legal business name
NW INTERVENTIONAL MEDICINE AND ORTHOPEDIC REHAB PLLC
Practice address
11802 NE 65TH St.
Vancouver, WA 98662
Phone
(360) 253-6883
Fax
(360) 892-7040
NPI assigned
Apr 18, 2016
Last updated
Apr 18, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 18, 2016

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

Authorized official

Name
Mike Back, DC
Title
Owner/Manager
Phone
(360) 253-6883

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X NU Primary

Addresses

Primary practice location

11802 NE 65TH St.
Vancouver, WA 98662

Mailing address

11802 NE 65TH St.
Vancouver, WA 98662
Phone (360) 253-6883

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20160810003013 WA Part B Supplier - Clinic/Group Practice 3375837560 Receives reassigned benefits from 2 practitioners
Practice locations: Vancouver, WA
O20170419001490 WA DME Supplier - Physician - Physical and Rehabilitation 3375837560 Practice locations: Vancouver, WA

National Provider Directory

National Provider Directory

Locations

11802 NE 65th St
Ste 100
Vancouver, WA 98662
Phone (360) 253-6883

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1460937600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1460937600000",
    "number": "1982058814",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11802 NE 65TH ST.",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "98662",
            "telephone_number": "360-253-6883",
            "fax_number": "360-892-7040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11802 NE 65TH ST.",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "98662",
            "telephone_number": "360-253-6883",
            "fax_number": "360-892-7040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NW INTERVENTIONAL MEDICINE AND ORTHOPEDIC REHAB PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-18",
        "last_updated": "2016-04-18",
        "status": "A",
        "authorized_official_last_name": "BACK",
        "authorized_official_first_name": "MIKE",
        "authorized_official_title_or_position": "OWNER/MANAGER",
        "authorized_official_telephone_number": "360-253-6883",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "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 Apr 18, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.