NICHOLAS TAYLOR DULETZKE
NPI 1417319922
Surgery - Trauma Surgery in Vancouver, WA

Q: What is Nicholas Duletzke's NPI number?

The NPI number for Nicholas Duletzke is 1417319922. It was assigned to this individual provider in the NPPES registry on March 23, 2016.

Q: What is Nicholas Duletzke's specialty?

The primary specialty registered for this NPI is Surgery, specializing in Trauma Surgery, with taxonomy code 2086S0127X.

Q: When was this NPI record last updated?

The NPPES record for Nicholas Duletzke was last updated on June 8, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since March 23, 2016PECOS EnrolledAccepts Medicare Assignment

505 NE 87TH AVE STE 301, VANCOUVER, WA 98664(360) 514-1854(360) 514-6063 Get Directions Write a Review

NPPES record last updated: June 8, 2022. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Jun 8, 2022, Mar 23, 2016 (2 updates tracked since 2016).

On this page

About Nicholas Taylor Duletzke NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

NICHOLAS TAYLOR DULETZKE (NPI 1417319922) is an individual trauma surgery provider in Vancouver, Washington, licensed in Washington (MD61281239) and active in the NPI registry since March 2016. He is enrolled in Medicare PECOS, is affiliated with Peacehealth Southwest Medical Center, and maintains a secondary practice location in Salt Lake City.

NPPES Registry Identity

NPI1417319922

Entity TypeIndividualMale

Primary Taxonomy2086S0127X

Provider Legal NameNICHOLAS TAYLOR DULETZKE

Location Address505 NE 87TH AVE STE 301Vancouver, WA 98664-1965

Mailing Address30 N 1900 ESalt Lake City, UT 84132-0002 · (801) 581-6803

Phone(360) 514-1854

Fax(360) 514-6063

Sole ProprietorYes

Medical School CMSOregon Health Sciences University School Of MedicineGraduated 2016

Enumeration DateMarch 23, 2016

Last NPPES UpdateJune 8, 20222 updates tracked since enumeration

NPPES CertifiedJune 8, 2022

✔ NPI 1417319922 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 4

★ Primary SpecialtySurgery · Trauma SurgeryAllopathic & Osteopathic Physicians

Taxonomy Code2086S0127X

License✔ Licensed in WA · MD61281239

Definition

Trauma surgery is a recognized subspecialty of general surgery. Trauma surgeons are physicians who have completed a five-year general surgery residency and usually continue with a one to two year fellowship in trauma and/or surgical critical care, typically leading to additional board certification in surgical critical care. There is no trauma surgery board certification at this point. To obtain board certification in surgical critical care, a fellowship in surgical critical care or anesthesiology critical care must be completed during or after general surgery residency.

Also ListedSurgeryTaxonomy 208600000X · License MD61281239 (WA)

Also ListedSurgery · Surgical Critical CareTaxonomy 2086S0102X · License MD61281239 (WA)

Also ListedStudent in an Organized Health Care Education/Training ProgramTaxonomy 390200000X

505 NE 87TH AVE STE 301, Vancouver, WA 98664

Open in Google Maps ↗

Secondary Practice Location 1

Location 130 N 1900 ESalt Lake City, UT 84132-0002 · Phone (801) 581-6803

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter Health, BridgeSpan Health Company, Kaiser Permanente and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Nicholas Taylor Duletzke is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID6204192826

PECOS Enrollment IDI20220802002699

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignments

Medicare enrollment records show Nicholas Duletzke reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Peacehealth

Same address

Surgery

505 NE 87TH AVE, SUITE 301
Vancouver, WA 98664

Reassigned Medicare billing, Washington enrollment
307 clinicians in this Medicare group

NPI 1609061969 (360) 514-7374

Peacehealth

39 mi

Multi-Specialty

1615 DELAWARE ST
Longview, WA 98632

Reassigned Medicare billing, Washington enrollment
308 clinicians in this Medicare group

NPI 1720056187 (360) 414-2000

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Areas of Expertise CMS Part B claims 2

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes 99232

Follow-up hospital inpatient care involves daily check-ups while you're admitted in the hospital. Typically, a healthcare provider spends about 25 minutes each day reviewing your condition, adjusting treatment if needed, and answering any questions you might have.

17 services14 patients

Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes 99222

Initial hospital inpatient care is a service where a healthcare provider spends about 50 minutes per day overseeing your care while you're admitted in the hospital. This includes reviewing your health status, planning your treatment, and ensuring your safety and comfort.

12 services12 patients

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Peacehealth Southwest Medical Center

Acute Care Hospitals · Vancouver, WA

4/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number500050

Location400 NE Mother Joseph PlaceVancouver, WA 98668 · Clark County

Emergency services Birthing friendly

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

COURTNEY ALYSON GREEN M.D.

Surgery (Trauma Surgery)