Active NPI
Steven Louis Nickman, MD
- Psychiatry Physician
- Chestnut Hill, MA
National Provider Identifier
1104881432
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 32763
- Practice address
- 26 Holly LN Apt 2B
Chestnut Hill, MA 02467-2155 - Phone
- (617) 734-3016
- Fax
- (617) 739-8286
- NPI assigned
- Apr 19, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 32763 | MA | |
| Psychiatry Physician | 2084P0800X | 32763 | MA | Primary |
Addresses
Primary practice location
26 Holly LN Apt 2B
Chestnut Hill, MA 02467-2155
Mailing address
26 Holly LN Apt 2B
Chestnut Hill, MA 02467-2155
Phone (617) 734-3016
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2012847 | Medicaid | MA | |
| 032763 | Other | MA | TUFTS HEALTH PLAN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Apr 1, 2016 through Apr 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1145404800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1665705600000",
"number": "1104881432",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "26 HOLLY LN APT 2B",
"city": "CHESTNUT HILL",
"state": "MA",
"postal_code": "024672155",
"telephone_number": "617-734-3016",
"fax_number": "617-739-8286"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "26 HOLLY LN APT 2B",
"city": "CHESTNUT HILL",
"state": "MA",
"postal_code": "024672155",
"telephone_number": "617-734-3016",
"fax_number": "617-739-8286"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NICKMAN",
"first_name": "STEVEN",
"middle_name": "LOUIS",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-04-19",
"last_updated": "2022-10-14",
"certification_date": "2022-10-14",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "MA",
"license": "32763",
"primary": false
},
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "MA",
"license": "32763",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2012847",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TUFTS HEALTH PLAN",
"identifier": "032763",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Chestnut Hill, MA
- New England Orthopaedic & Spine Surgery, LLC
- New England Podiatry Associates, P.C.
- New England Reconstructive & Aesthetic Surgery, PC
- Newton Pediatrics LLC (Krisztina Bukur-doczy)
- Betty Bet-Ling NG, MD
- Amanda Marie Nicoles, ATC, LAT
- Mark Nissenbaum, DMD MDC FCDSA OMFS
- Saritha Nitin
- Amelia Nodell, PT, DPT
- Anne E Norris, PHD, RNCS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2022; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.