Active NPI
Michael Kiamos Nicholas, RN, MSN, PMHNP-BC
- Psychiatric/Mental Health Nurse Practitioner
- Berkeley, CA
National Provider Identifier
1275262214
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner
- License
- NP95019631
- Practice address
- 3075 Adeline St.
#280
Berkeley, CA 94703 - Phone
- (510) 981-4100
- NPI assigned
- Jun 6, 2022
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | NP95019631 | CA | Primary |
Addresses
Primary practice location
3075 Adeline St.
#280
Berkeley, CA 94703
Mailing address
3075 Adeline St Ste 280
Berkeley, CA 94703-2580
Phone (510) 981-4100
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240919004164 | CA | Order and Referring Only - Nurse Practitioner | 4789125584 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Science - Nursing, Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| NP95019631 | CA | MD | Psychiatric/Mental Health Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1654473600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1670544000000",
"number": "1275262214",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3075 ADELINE ST STE 280",
"city": "BERKELEY",
"state": "CA",
"postal_code": "947032580",
"telephone_number": "510-981-4100"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3075 ADELINE ST.",
"address_2": "#280",
"city": "BERKELEY",
"state": "CA",
"postal_code": "94703",
"telephone_number": "510-981-4100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NICHOLAS",
"first_name": "MICHAEL",
"middle_name": "KIAMOS",
"credential": "RN, MSN, PMHNP-BC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-06-06",
"last_updated": "2022-12-09",
"certification_date": "2022-12-09",
"status": "A"
},
"taxonomies": [
{
"code": "363LP0808X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Psychiatric/Mental Health",
"state": "CA",
"license": "NP95019631",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Berkeley, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2022; 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.