Individual provider Active NPI

Christopher James Nickel, MD

  • Plastic Surgery within the Head & Neck (Otolaryngology) Physician
  • Atlanta, GA
National Provider Identifier
1194111963
Registry record updated Aug 12, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic Surgery within the Head & Neck (Otolaryngology) PhysicianTaxonomy code 207YX0007X
License
ME151039 Issued in FL
Practice address
550 Peachtree St NE Ste 1135
Atlanta, GA 30308-2234
Phone
(404) 778-3381
NPI assigned
Apr 8, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 12, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X 85394 GA
Student in an Organized Health Care Education/Training Program 390200000X
Plastic Surgery within the Head & Neck (Otolaryngology) Physician 207YX0007X ME151039 FL Primary

Addresses

Primary practice location

550 Peachtree St NE Ste 1135
Atlanta, GA 30308-2234

Mailing address

550 Peachtree St NE Ste 1135
Atlanta, GA 30308-2234
Phone (404) 778-3381

Other practice location 1

17 Davis Blvd
Suite 308
Tampa, FL 33606-3475
Phone (813) 974-2406

Other practice location 2

13330 Usf Laurel Dr
Tampa, FL 33612-6601
Phone (813) 974-2201

Other identifiers 1

IdentifierTypeStateIssuer
YH196OtherFLBCBS

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address cnickel192053@direct.tgh.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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 1

Enrollment IDStateProvider typePAC IDDetails
I20210810002669 FL Practitioner - Otolaryngology 1759704570 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
Other, 2015
Medicare assignment
May accept Medicare assignment
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

13330 Usf Laurel Dr
Tampa, FL 33612-6601

4202 E Fowler Ave
Tampa, FL 33620-6750

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
85394GAMDOtolaryngology Physician
ME151039FLMDPlastic Surgery within the Head & Neck (Otolaryngology) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University Medical Service Association Inc CurrentSince Jun 22, 2021 Accepting new patients
University Medical Service Association Inc Current Accepting new patients
Tampa General Hospital Current Accepting new patients
University Medical Service Association Inc Otolaryngology CurrentSince Jun 22, 2021 Accepting new patients
University Medical Service Association Inc Past Accepting new patients

Locations

4202 E Fowler Ave
Stop SHS100
Tampa, FL 33620
Phone (813) 974-2331

2 Tampa General Cir
Tampa, FL 33606
Phone (813) 259-8500

12901 Bruce B Downs Blvd
#62
Tampa, FL 33612

13330 Usf Laurel Dr
Tampa, FL 33612
Phone (813) 396-9478

13330 Usf Laurel Dr
Fl 3
Tampa, FL 33612
Phone (813) 396-9422

12901 Bruce B Downs Blvd
#19
Tampa, FL 33612
Phone (813) 974-1469

Networks

  • Freedom Health HMO Network

Interoperability endpoints

  • FHIR API: https://epicproxy.et0761.epichosted.com/FHIRProxy/api/FHIR/R4/

Organizations & group practices 5

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1428451200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1628726400000",
    "number": "1194111963",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "550 PEACHTREE ST NE STE 1135",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303082234",
            "telephone_number": "404-778-3381"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "550 PEACHTREE ST NE STE 1135",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303082234",
            "telephone_number": "404-778-3381"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "17 Davis Blvd",
            "address_2": "Suite 308",
            "address_purpose": "LOCATION",
            "city": "Tampa",
            "state": "FL",
            "postal_code": "336063475",
            "country_code": "US",
            "telephone_number": "813-974-2406",
            "fax_number": "813-974-7314",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "13330 Usf Laurel Dr",
            "address_purpose": "LOCATION",
            "city": "Tampa",
            "state": "FL",
            "postal_code": "336126601",
            "country_code": "US",
            "telephone_number": "813-974-2201",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NICKEL",
        "first_name": "CHRISTOPHER",
        "middle_name": "JAMES",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-04-08",
        "last_updated": "2021-08-12",
        "certification_date": "2021-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "GA",
            "license": "85394",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207YX0007X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Plastic Surgery within the Head & Neck",
            "state": "FL",
            "license": "ME151039",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "YH196",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cnickel192053@direct.tgh.org",
            "affiliation": "N",
            "address_1": "13330 Usf Laurel Dr",
            "city": "Tampa",
            "state": "FL",
            "country_code": "US",
            "postal_code": "336126601",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

Verify at the official NPI Registry.