Nichole Barton Tomblin

Primary specialty

DentistTaxonomy code 122300000X

License

DE60708382 Issued in WA

Practice address

210 Government Rd
Mattawa, WA 99349-5116

Phone

(509) 932-4499

Fax

(099) 325-3635

NPI assigned

Feb 6, 2016

Last updated

Jan 27, 2025By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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 WA

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: nichole.barton.tomblin.1@8515.direct.athenahealth.com

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.

• Grant County Public Hospital District No 5

  dba Mattawa Community Medical Clinic

  • Federally Qualified Health Center (FQHC)
  • Mattawa, WA
  • NPI 1699720797
  Medicare reassignment NPD
• Grant County Public Hospital District No 5

  dba Mattawa Community Medical Clinic

  • Federally Qualified Health Center (FQHC)
  • Mattawa, WA
  • NPI 1013743210
  NPD

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

{
    "created_epoch": "1454716800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737936000000",
    "number": "1114385044",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 GOVERNMENT RD",
            "city": "MATTAWA",
            "state": "WA",
            "postal_code": "993495116",
            "telephone_number": "509-932-4499",
            "fax_number": "099-325-3635"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 GOVERNMENT RD",
            "city": "MATTAWA",
            "state": "WA",
            "postal_code": "993495116",
            "telephone_number": "509-932-4499",
            "fax_number": "099-325-3635"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1515 E Columbia St",
            "address_purpose": "LOCATION",
            "city": "Othello",
            "state": "WA",
            "postal_code": "993441846",
            "country_code": "US",
            "telephone_number": "509-488-5256",
            "fax_number": "509-488-9939",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BARTON TOMBLIN",
        "first_name": "NICHOLE",
        "name_prefix": "Dr.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-02-06",
        "last_updated": "2025-01-27",
        "certification_date": "2025-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WA",
            "license": "DE60708382",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2072503",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Dentist in Mattawa, WA
• Providers in Mattawa, WA by specialty
• Dentist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2025; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.