Tim McNicoll MD Inc

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

G48100 Issued in CA

Legal business name

TIM MCNICOLL MD INC

Practice address

2876 Sycamore Dr
Suite 101
Simi Valley, CA 93065-1530

Phone

(805) 527-6424

Fax

(805) 522-0115

NPI assigned

Nov 21, 2008

Organization subpart

No

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

Authorized official

Name

Timothy J McNicoll, MDNPI 1790750115

Title

President/Owner

Phone

(805) 527-6424

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Timothy J McNicoll, M.D.

  • Hospitalist Physician
  • Stamford, CT
  • NPI 1790750115

  CA, Family Medicine

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1227225600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1233619200000",
    "number": "1144475864",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2876 SYCAMORE DR",
            "address_2": "SUITE 101",
            "city": "SIMI VALLEY",
            "state": "CA",
            "postal_code": "930651530",
            "telephone_number": "805-527-6424",
            "fax_number": "805-522-0115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2876 SYCAMORE DR",
            "address_2": "SUITE 101",
            "city": "SIMI VALLEY",
            "state": "CA",
            "postal_code": "930651530",
            "telephone_number": "805-527-6424",
            "fax_number": "805-522-0115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIM MCNICOLL MD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-11-21",
        "last_updated": "2009-02-03",
        "status": "A",
        "authorized_official_last_name": "MCNICOLL",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "805-527-6424",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "G48100",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G481000",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mark Thompson, PTA
• Thrifty Payless Inc
• Thrifty Payless Inc
• Connaitre Shante Tillman
• Saudia Sumaiyah Tillman
• Teri K Tingey
• Kaycee Tinsman
• Lauren Ashley Titelman
• Jasbir Singh Tiwana, M.D
• Gerri Todd, MFT

• Family Medicine Physician in Simi Valley, CA
• Providers in Simi Valley, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2009; 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.