NPIMap

Individual provider Active NPI

Nicholls Nelson, MD

  • Emergency Medicine Physician
  • Louisville, KY
National Provider Identifier
1194257212
Registry record updated Jul 20, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
53927 Issued in KY
Practice address
1 Audubon Plaza Dr
Louisville, KY 40217-1318
Phone
(502) 634-6767
NPI assigned
Mar 29, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 20, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 53927 KY Primary

Addresses

Primary practice location

1 Audubon Plaza Dr
Louisville, KY 40217-1318

Mailing address

PO Box 36218
Louisville, KY 40233-6218
Phone (502) 634-6767

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY, CO2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20190320003426 KY Practitioner - Emergency Medicine 4284983180 Reassigns benefits to 4 organizations
I20220810002379 CO Practitioner - Emergency Medicine 4284983180 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
University of Louisville School of Medicine, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Valley View Hospital AssociationGroup PAC ID 1850294778, shared by 23 NPIs, 205 clinicians
Colorado West Emergency Physicians LLCGroup PAC ID 6103808035, 21 clinicians

Practice addresses (Care Compare)

1906 Blake Ave
Glenwood SPGS, CO 81601-4227

2635 N 7TH St
Grand Junction, CO 81501-8209
Phone (970) 244-2273

Hospital & facility affiliations

  • Grand River Hospital District Hospital, Rifle, CO, CCN 061317
  • Intermountain Health St. Mary'S Regional Hospital Hospital, Grand Junction, CO, CCN 060023
  • Valley View Hospital Association Hospital, Glenwood Springs, CO, CCN 060075

Merit-based Incentive Payment System (MIPS)

Final score
98.63 of 100Reported as group
Quality
97.27
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
94.89 of 100Reported as apm
Quality
86.88
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
53927KYMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southeastern Emergency Physicians LLC Emergency Medicine CurrentSince Sep 1, 2020 Accepting new patients
Southern Medical Partners, LLC Emergency Medicine CurrentSince Feb 28, 2021 Accepting new patients
Grand River Hospital District CurrentSince Sep 12, 2022 Accepting new patients
Grand River Hospital District Current Accepting new patients
Floyd Emergency Group, LLC Emergency Medicine CurrentSince Feb 28, 2021 Accepting new patients
Grand River Hospital District Current Accepting new patients
Cardinal Pathology PC Current Accepting new patients
Grand River Hospital District CurrentSince Sep 12, 2022 Accepting new patients
Colorado West Emergency Physicians, LLC Emergency Medicine CurrentSince Jul 31, 2023 Accepting new patients

Locations

Dept 0861
Denver, CO 80256
Phone (970) 298-1977

1906 Blake Ave
Glenwood Springs, CO 81601
Phone (970) 384-7033

2635 N 7th St
Grand Junction, CO 81501
Phone (970) 244-2009

501 Airport Rd
Rifle, CO 81650
Phone (970) 625-1100

1700 Old Lebanon Rd
Campbellsvlle, KY 42718
Phone (270) 465-3561

1 Trillium Way
Corbin, KY 40701
Phone (606) 523-8521

1850 Bluegrass Ave
Louisville, KY 40215
Phone (502) 361-6617

5000 Ky Route 321
Prestonsburg, KY 41653
Phone (606) 886-7645

Organizations & group practices 12

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.

Hospital & facility affiliations 7

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": "1490745600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1595203200000",
    "number": "1194257212",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 36218",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402336218",
            "telephone_number": "502-634-6767",
            "fax_number": "502-634-6775"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 AUDUBON PLAZA DR",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402171318",
            "telephone_number": "502-634-6767"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NELSON",
        "first_name": "NICHOLLS",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-03-29",
        "last_updated": "2020-07-20",
        "certification_date": "2020-07-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "KY",
            "license": "53927",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Louisville, KY

Sources for this page

Verify at the official NPI Registry.