Individual provider Active NPI

Dayne Timothy Mickelson, M.D.

  • Orthopaedic Surgery Physician
  • Bellevue, WA
National Provider Identifier
1982903142
Registry record updated May 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License
MD60476167 Issued in WA
Practice address
3101 Northup Way Ste 201
Bellevue, WA 98004-1435
Phone
(425) 455-3600
Fax
(425) 455-3920
NPI assigned
Mar 26, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 23, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Orthopaedic Surgery) Physician 207XX0005X MD60476167 WA
Orthopaedic Surgery Physician 207X00000X MD60476167 WA Primary

Addresses

Primary practice location

3101 Northup Way Ste 201
Bellevue, WA 98004-1435

Mailing address

510 8TH Ave NE Ste 320
Issaquah, WA 98029-5436
Phone (425) 507-0733

Other practice location 1

510 8th Ave NE Ste 200
Issaquah, WA 98029-5436
Phone (425) 392-3030

Other practice location 2

18100 NE Union Hill Rd Ste 330
Redmond, WA 98052-3330
Phone (425) 455-3600

Other practice location 3

515 Minor Ave Ste 200
Seattle, WA 98104-2133
Phone (425) 455-3600

Other identifiers 1

IdentifierTypeStateIssuer
2018712MedicaidWA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170927004799 WA Practitioner - Orthopedic SurgeryPractitioner - Sports Medicine 6709100506 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic SurgeryAlso: Sports Medicine
Education
University of Washington School of Medicine, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Proliance Surgeons Inc P SGroup PAC ID 8527972900, 395 clinicians

Practice addresses (Care Compare)

510 8TH Ave NE
Suite 200
Issaquah, WA 98029-5436
Phone (425) 392-3030

Hospital & facility affiliations

  • Overlake Hospital Medical Center & Clinics Hospital, Bellevue, WA, CCN 500051
  • Swedish Issaquah Hospital, Issaquah, WA, CCN 500152

Procedures performed for Medicare patients

ProcedureNumber of procedures
Knee replacement15
Lower limb (leg) arthroscopy (minimally invasive joint repair)26
Upper limb (arm) arthroscopy (minimally invasive joint repair)22

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD60476167WAMDOrthopaedic Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Proliance Surgeons, Inc., P.S. CurrentSince Sep 18, 2017 Accepting new patients
Proliance Surgeons Inc P S Orthopaedic Surgery CurrentSince Sep 18, 2017 Accepting new patients
Proliance Surgeons Inc P S Orthopaedic Surgery Current Accepting new patients
Proliance Surgeons, Inc., P.S. Past Accepting new patients

Locations

3101 Northup Way
Ste 201
Bellevue, WA 98004
Phone (425) 455-3600

1231 116th Ave NE
Ste 750
Bellevue, WA 98004
Phone (425) 455-3600

510 8th Ave NE
Ste 200
Issaquah, WA 98029
Phone (425) 392-3030

12911 120th Ave NE
Ste H120
Kirkland, WA 98034
Phone (425) 823-4226

18100 NE Union Hill Rd
Ste 330
Redmond, WA 98052
Phone (425) 392-3030

515 Minor Ave
Ste 200
Seattle, WA 98104
Phone (206) 386-9615

805 Madison St
Ste 901
Seattle, WA 98104
Phone (206) 264-8100

Organizations & group practices 4

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.

Hospital & facility affiliations 3

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": "1301097600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1716422400000",
    "number": "1982903142",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "510 8TH AVE NE STE 320",
            "city": "ISSAQUAH",
            "state": "WA",
            "postal_code": "980295436",
            "telephone_number": "425-507-0733"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3101 NORTHUP WAY STE 201",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980041435",
            "telephone_number": "425-455-3600",
            "fax_number": "425-455-3920"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "510 8th Ave NE Ste 200",
            "address_purpose": "LOCATION",
            "city": "Issaquah",
            "state": "WA",
            "postal_code": "980295436",
            "country_code": "US",
            "telephone_number": "425-392-3030",
            "fax_number": "425-392-2564",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "18100 NE Union Hill Rd Ste 330",
            "address_purpose": "LOCATION",
            "city": "Redmond",
            "state": "WA",
            "postal_code": "980523330",
            "country_code": "US",
            "telephone_number": "425-455-3600",
            "fax_number": "425-455-3920",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "515 Minor Ave Ste 200",
            "address_purpose": "LOCATION",
            "city": "Seattle",
            "state": "WA",
            "postal_code": "981042133",
            "country_code": "US",
            "telephone_number": "425-455-3600",
            "fax_number": "425-455-3920",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MICKELSON",
        "first_name": "DAYNE",
        "middle_name": "TIMOTHY",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-03-26",
        "last_updated": "2024-05-23",
        "certification_date": "2024-05-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207XX0005X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": "WA",
            "license": "MD60476167",
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "WA",
            "license": "MD60476167",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2018712",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bellevue, WA

Sources for this page

Verify at the official NPI Registry.