NPIMap

Individual provider Active NPI

Nicole Renee Sydow, M.D.

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Flagstaff, AZ
National Provider Identifier
1255598900
Registry record updated Feb 19, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianTaxonomy code 208G00000X
License
46018 Issued in AZ
Practice address
1215 N Beaver St
Suite 203
Flagstaff, AZ 86001-3126
Phone
(928) 773-2150
NPI assigned
May 20, 2008
Last updated
Feb 19, 2016By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 19, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 57.012994 OH
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician 208G00000X 46018 AZ Primary

Addresses

Primary practice location

1215 N Beaver St
Suite 203
Flagstaff, AZ 86001-3126

Mailing address

3131 E Clarendon Ave
Suite 102
Phoenix, AZ 85016-7069
Phone (602) 253-9168

Other names 1

  • Nicole Renee Collins Former name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140902002245 AZ Practitioner - Thoracic Surgery 9234357393 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Thoracic Surgery
Education
Southern Illinois University School of Medicine, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Phoenix Cardiac Surgery PCGroup PAC ID 8426943036, 11 clinicians

Practice addresses (Care Compare)

1215 N Beaver St
Suite 203
Flagstaff, AZ 86001-3126
Phone (928) 773-2150

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Coronary artery bypass graft (CABG)18
Pacemaker insertion or repair1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
57.012994OHMDSurgery Physician
46018AZMDThoracic Surgery (Cardiothoracic Vascular Surgery) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Phoenix Cardiac Surgery PC Thoracic Surgery (Cardiothoracic Vascular Surgery) CurrentSince Mar 1, 2016 Accepting new patients
Phoenix Cardiac Surgery Thoracic Surgery (Cardiothoracic Vascular Surgery) CurrentSince Mar 1, 2016 Accepting new patients
Flagstaff Medical Center Past Accepting new patients

Locations

1215 N Beaver St
#203
Flagstaff, AZ 86001
Phone (928) 773-2150

3131 E Clarendon Ave
Ste 102
Phoenix, AZ 85016
Phone (602) 253-9168

Organizations & group practices 3

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 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": "1211241600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1455840000000",
    "number": "1255598900",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3131 E CLARENDON AVE",
            "address_2": "SUITE 102",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850167069",
            "telephone_number": "602-253-9168",
            "fax_number": "602-251-3126"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1215 N BEAVER ST",
            "address_2": "SUITE 203",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "860013126",
            "telephone_number": "928-773-2150"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SYDOW",
        "first_name": "NICOLE",
        "middle_name": "RENEE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-05-20",
        "last_updated": "2016-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "OH",
            "license": "57.012994",
            "primary": false
        },
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "AZ",
            "license": "46018",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NICOLE",
            "last_name": "COLLINS",
            "middle_name": "RENEE",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Flagstaff, AZ

Sources for this page

Verify at the official NPI Registry.