Active NPI
Nicole Ann Raicik, PA-C
- Physician Assistant
- Jasper, AL
National Provider Identifier
1255192035
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA.2299
- Practice address
- 3400 Highway 78 E
Jasper, AL 35501-8956 - Phone
- (205) 387-4000
- NPI assigned
- Jan 19, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | PA.2299 | AL | |
| Surgical Physician Assistant | 363AS0400X | PA.2299 | AL | |
| Physician Assistant | 363A00000X | PA.2299 | AL | Primary |
Addresses
Primary practice location
3400 Highway 78 E
Jasper, AL 35501-8956
Mailing address
3550 Grandview Pkwy Apt 223
Birmingham, AL 35243-1988
Phone (678) 756-1303
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA.2299 | AL | MD | Surgical Physician Assistant |
Organizations & group practices 2
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.
-
- Emergency Medicine Physician
- Talladega, AL
- NPI 1477708857
-
- Emergency Medicine Physician
- Birmingham, AL
- NPI 1225071459
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1705622400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1705622400000",
"number": "1255192035",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3550 GRANDVIEW PKWY APT 223",
"city": "BIRMINGHAM",
"state": "AL",
"postal_code": "352431988",
"telephone_number": "678-756-1303"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3400 HIGHWAY 78 E",
"city": "JASPER",
"state": "AL",
"postal_code": "355018956",
"telephone_number": "205-387-4000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RAICIK",
"first_name": "NICOLE",
"middle_name": "ANN",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-01-19",
"last_updated": "2024-01-19",
"certification_date": "2024-01-19",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "AL",
"license": "PA.2299",
"primary": false
},
{
"code": "363AS0400X",
"taxonomy_group": "",
"desc": "Physician Assistant, Surgical",
"state": "AL",
"license": "PA.2299",
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "AL",
"license": "PA.2299",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jasper, AL
- Dusty Leigh Pruett, PHARM D
- Tiffany Pugh, BS
- Pulmonary and Sleep Associates of Jasper, PC
- Quest Diagnostics Clinical Laboratories Inc
- Radiology Associates of North Alabama
- Callie Reed, M.S. CCC-SLP
- Regional Air Medical Services, Inc
- Regional Paramedical Services Inc
- Regional Paramedical Services of Hamilton Inc
- Regional Paramedical Services of St Clair Inc
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.