Individual provider Active NPI

Jason T. Nieves, MD

  • Vascular Surgery Physician
  • Eglin AFB, FL
National Provider Identifier
1194088369
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
License
A127611 Issued in CA
Practice address
307 Boatner Rd Ste 114
Eglin AFB, FL 32542-1302
Phone
(850) 883-8600
NPI assigned
Jun 21, 2012
Last updated
Jul 21, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular Surgery Physician 2086S0129X A127611 CA Primary

Addresses

Primary practice location

307 Boatner Rd Ste 114
Eglin AFB, FL 32542-1302

Mailing address

307 Boatner Rd Ste 114
Eglin AFB, FL 32542-1302
Phone (850) 883-8600

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL, SC, CO3 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20190123001908 FL Practitioner - Vascular Surgery 2961749353 Reassigns benefits to 2 organizations
I20241017000587 SC Practitioner - Vascular Surgery 2961749353 Reassigns benefits to 2 organizations
I20250603003809 CO Practitioner - Vascular Surgery 2961749353 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
94.7 of 100Reported as apm
Quality
89.4
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A127611CAMDVascular Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Spartanburg Medical Center Vascular Surgery CurrentSince Aug 6, 2024 Accepting new patients
Self Medical Group Vascular Surgery CurrentSince Sep 15, 2025 Accepting new patients
Poudre Valley Medical Group, LLC CurrentSince Jun 1, 2025 Accepting new patients
Coastal Vascular and Interventional PLLC Vascular Surgery CurrentSince Dec 1, 2018 Accepting new patients
Poudre Valley Medical Group, LLC CurrentSince Jun 1, 2025 Accepting new patients
Self Medical Group CurrentSince Sep 15, 2025 Accepting new patients
Spartanburg Medical Center Current Accepting new patients
Cardiothoracic & Vascular Surgical Associates PA Vascular Surgery CurrentSince Apr 1, 2021 Accepting new patients
Spartanburg Medical Center CurrentSince Aug 6, 2024 Accepting new patients
Self Medical Group Current Accepting new patients

Locations

4404 Barranca Ln
Castle Rock, CO 80104
Phone (720) 733-5260

1401 Court St
Pueblo, CO 81003
Phone (719) 562-2300

327 Medcrest Dr
Unit B
Crestview, FL 32536
Phone (850) 682-0032

332 Medcrest Dr
Crestview, FL 32536
Phone (850) 226-7322

4012 Commons Dr W
Ste 110
Destin, FL 32541
Phone (850) 434-7331

1824 King St
Ste 200
Jacksonville, FL 32204
Phone (904) 384-3343

5970 Berryhill Rd
Milton, FL 32570

7720 US Highway 98 W
Ste 240
Miramar Beach, FL 32550
Phone (850) 502-5989

1851 N 9th Ave
Ste B
Pensacola, FL 32503
Phone (850) 479-4223

2301 N 9th Ave
Ste 100
Pensacola, FL 32503
Phone (850) 912-8249

4451 Bayou Blvd
Pensacola, FL 32503
Phone (850) 416-7619

5149 N 9th Ave
Ste 120
Pensacola, FL 32504
Phone (850) 426-5191

75 Remittance Dr
Dept 6764
Chicago, IL 60675

160 Academy Ave
Greenwood, SC 29646
Phone (864) 223-8090

2605 Kinard St
Ste 200
Newberry, SC 29108
Phone (803) 276-1866

101 E Wood St
Ste 300
Spartanburg, SC 29303
Phone (864) 560-6554

225 E Wood St
Spartanburg, SC 29303
Phone (864) 560-4420

853 N Church St
Ste 410A
Spartanburg, SC 29303
Phone (864) 560-6928

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

Interoperability endpoints

  • Direct secure messaging: jason.nieves@hca5.eclinicaldirectplus.com
  • Direct secure messaging: jnieves@cvi.curemd.direct-ci.com
  • Direct secure messaging: jnieves574396@selfregional.direct-ci.net

Organizations & group practices 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1340236800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1194088369",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "307 BOATNER RD STE 114",
            "city": "EGLIN AFB",
            "state": "FL",
            "postal_code": "325421302",
            "telephone_number": "850-883-8600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "307 BOATNER RD STE 114",
            "city": "EGLIN AFB",
            "state": "FL",
            "postal_code": "325421302",
            "telephone_number": "850-883-8600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NIEVES",
        "first_name": "JASON",
        "middle_name": "T.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-06-21",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "CA",
            "license": "A127611",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Eglin AFB, FL

Sources for this page

Verify at the official NPI Registry.