NPIMap

Individual provider Active NPI

Nicki Niemann, M.D.

  • Neurology Physician
  • Phoenix, AZ
National Provider Identifier
1093154072
Registry record updated Jan 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
57232 Issued in AZ
Practice address
240 W Thomas Rd
# 301
Phoenix, AZ 85013-8581
Phone
(602) 406-6262
Fax
(602) 406-6261
NPI assigned
Jun 23, 2013
Last updated
Jan 30, 2020By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 30, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X 575192 TX
Neurology Physician 2084N0400X 57232 AZ Primary

Addresses

Primary practice location

240 W Thomas Rd
# 301
Phoenix, AZ 85013-8581

Mailing address

240 W Thomas Rd
# 301
Phoenix, AZ 85013-8581
Phone (602) 406-6262

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ, TX2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20190523001905 AZ Practitioner - Neurology 1850634387 Reassigns benefits to 1 organization
I20220621000289 TX Practitioner - Neurology 1850634387 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
BHSM Rehabilitation LLCGroup PAC ID 2062773138, shared by 27 NPIs, 450 clinicians
Sjhmc Physician ServicesGroup PAC ID 4486646197, 645 clinicians

Practice addresses (Care Compare)

103 Medicine Way Rd
Peridot, AZ 85542-0787
Phone (928) 475-1400

2225 W Southern Ave
Mesa, AZ 85202-4716
Phone (623) 888-3502

500 W Thomas Rd
680 DHMG St Joseph's Pelvic Pain and Surg
Phoenix, AZ 85013-4235
Phone (602) 406-6017

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
57232AZMDNeurology Physician
575192TXMDNeurology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St. Joseph's Hospital and Medical Center Multi-Specialty CurrentSince Aug 30, 2020 Accepting new patients
St Josephs Pathology Multi-Specialty Current Accepting new patients
San Carlos Apache Healthcare Corporation Multi-Specialty Current Accepting new patients
St. Joseph's Outpatient Surgery Center, LLC Current Accepting new patients
Sjhmc Physician Services Multi-Specialty CurrentSince Jun 15, 2019 Accepting new patients
San Carlos Apache Healthcare Corporation CurrentSince May 25, 2022 Accepting new patients
Dignity Health Past Accepting new patients

Locations

103 Medicine Way Rd
Peridot, AZ 85542
Phone (928) 475-1200

240 W Thomas Rd
#301
Phoenix, AZ 85013
Phone (602) 406-6262

240 W Thomas Rd
Ste 301
Phoenix, AZ 85013
Phone (602) 406-6262

350 W Thomas Rd
Phoenix, AZ 85013
Phone (480) 339-5001

500 W Thomas Rd
Ste 680
Phoenix, AZ 85013
Phone (602) 406-6017

File 56765
Los Angeles, CA 90074

Organizations & group practices 7

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.

Hospital & facility affiliations 9

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": "1371945600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1580342400000",
    "number": "1093154072",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "240 W THOMAS RD",
            "address_2": "# 301",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850138581",
            "telephone_number": "602-406-6262",
            "fax_number": "602-406-6261"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "240 W THOMAS RD",
            "address_2": "# 301",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850138581",
            "telephone_number": "602-406-6262",
            "fax_number": "602-406-6261"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NIEMANN",
        "first_name": "NICKI",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-06-23",
        "last_updated": "2020-01-30",
        "certification_date": "2020-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "TX",
            "license": "575192",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "AZ",
            "license": "57232",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.