Nickolas Fedack, DNP, CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

1087313 Issued in TX

Practice address

5005 N. Piedras St.
El Paso, TX 79920-5001

Phone

(915) 742-1970

NPI assigned

Jan 25, 2021

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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 and National Provider Directory roles.

• El Paso Ams, PLLC

  • Anesthesiology Physician
  • El Paso, TX
  • NPI 1134740202

  Nurse Anesthetist, Certified Registered

  Medicare reassignment NPD
• El Paso County Hospital District

  • General Acute Care Hospital
  • El Paso, TX
  • NPI 1316936990
  Medicare reassignment NPD
• Texas Ams PLLC

  • Anesthesiology Physician
  • Pensacola, FL
  • NPI 1174926125

  TX

  Medicare reassignment
• El Paso County Hospital District

  • General Acute Care Hospital
  • El Paso, TX
  • NPI 1619747938
  NPD

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

{
    "created_epoch": "1611532800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689724800000",
    "number": "1124618061",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18511 HIGHLANDER MEDICS ST",
            "city": "FORT BLISS",
            "state": "TX",
            "postal_code": "799065327",
            "telephone_number": "915-742-7777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5005 N. PIEDRAS ST.",
            "city": "EL PASO",
            "state": "TX",
            "postal_code": "799205001",
            "telephone_number": "915-742-1970"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FEDACK",
        "first_name": "NICKOLAS",
        "credential": "DNP, CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-01-25",
        "last_updated": "2023-07-19",
        "certification_date": "2023-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "TX",
            "license": "1087313",
            "primary": true
        },
        {
            "code": "163WC0200X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Critical Care Medicine",
            "state": "CO",
            "license": "RN.1638551",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Margarita Favela, FNP-C
• Mariaitzel Favela, LPC
• Samuel Humberto Favela Jr., O.D.
• Omar Favella
• Anaam Fayyaz, MD
• Rosa Maria Federico Ochoa, LPC
• Christina Federico
• Eric James Feely, CRNA
• Jennifer Elizabeth Feely, NP-C
• Steven J. Feinstein, M.D.

• Certified Registered Nurse Anesthetist in El Paso, TX
• Providers in El Paso, TX by specialty
• Certified Registered Nurse Anesthetist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.