David L Nichols, PHD

Primary specialty

Counseling PsychologistTaxonomy code 103TC1900X

License

943-057 Issued in WI

Practice address

8700 Durand Ave Ste 600
Sturtevant, WI 53177-2096

Phone

(262) 635-5520

Fax

(262) 635-5530

NPI assigned

Oct 5, 2005

Last updated

Mar 27, 2018By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

State University of New York at Buffalo School of Medicine, 1980

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Psychiatric Services of Racine LLPGroup PAC ID 1658377148, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Psychiatric Services of Racine, LLP

  • Prescribing (Medical) Psychologist
  • Sturtevant, WI
  • NPI 1699791988
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1128470400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1522108800000",
    "number": "1063409852",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8700 DURAND AVE STE 600",
            "city": "STURTEVANT",
            "state": "WI",
            "postal_code": "531772096",
            "telephone_number": "262-635-5520",
            "fax_number": "262-635-5530"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8700 DURAND AVE STE 600",
            "city": "STURTEVANT",
            "state": "WI",
            "postal_code": "531772096",
            "telephone_number": "262-635-5520",
            "fax_number": "262-635-5530"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1244 Wisconsin Ave Ste 303",
            "address_purpose": "LOCATION",
            "city": "Racine",
            "state": "WI",
            "postal_code": "534031987",
            "country_code": "US",
            "telephone_number": "262-635-5520",
            "fax_number": "262-635-5530",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NICHOLS",
        "first_name": "DAVID",
        "middle_name": "L",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-05",
        "last_updated": "2018-03-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "WI",
            "license": "943-057",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "39027600",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Thomas H Lim, DDS, MS
• Lincare Inc.
• Janice A Litza, MD
• Anthony Lotesto, DMD
• Lucy McAuley, PT
• Omni Human Performance Consulting
• Kristin Lynn Osgood Kotlewski, DDS
• Sabrina G Philip, D.D.S.
• Todd Edward Pienkos, DDS
• Pillpack LLC

• Counseling Psychologist in Sturtevant, WI
• Providers in Sturtevant, WI by specialty
• Counseling Psychologist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.