Active NPI
Julie Pandora Nickles, D.O.
- Family Medicine Physician
- Wilkes Barre, PA
National Provider Identifier
1285665570
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- OS004879L
- Practice address
- 175 S Wilkes Barre Blvd
Wilkes Barre, PA 18702-5040 - Phone
- (570) 829-2621
- Fax
- (570) 823-4332
- NPI assigned
- Jul 5, 2006
- Last updated
- Mar 13, 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | OS004879L | PA | Primary |
Addresses
Primary practice location
175 S Wilkes Barre Blvd
Wilkes Barre, PA 18702-5040
Mailing address
100 N Academy Ave
Danville, PA 17822-9800
Phone (570) 271-6144
Other practice location 1
4318 Mission Ave
Oceanside, CA 92057-6541
Phone (760) 901-5010
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 22143 | Other | PA | GEISINGER HEALTH PLAN |
| 0459530 | Other | PA | AETNA |
| 02713300 | Other | PA | CAPITAL BLUE CROSS |
| 2713300 | Other | PA | KHP CENTRAL |
| 431452 | Other | PA | CAPITAL BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in PA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Family Practice
- Education
- Other, 1981
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
175 S Wilkes Barre Blvd
Wilkes Barre, PA 18702-5040
Phone (570) 829-2621
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OS004879L | PA | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Scripps Health | Current | Accepting new patients | |
| Caring Community Health Center | Current | Accepting new patients | |
| Caring Community Health Center | Current | Accepting new patients |
Locations
100 N Academy Ave
Danville, PA 17822
426 Airport Rd
Ste 125
Hazle Township, PA 18202
Phone (570) 829-2621
175 S Wilkes Barre Blvd
Wilkes Barre, PA 18702
Phone (570) 821-0808
Interoperability endpoints
- jnickles168956@scrippshlth.medalliesdirect.net
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.
-
- Federally Qualified Health Center (FQHC)
- Wilkes Barre, PA
- NPI 1679038293
-
- Federally Qualified Health Center (FQHC)
- Scranton, PA
- NPI 1891547964
-
dba Scripps Hospital Medical Services
- General Acute Care Hospital
- San Diego, CA
- NPI 1487928891
Hospital & facility affiliations 20
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
dba Geisinger Pittston Radiology, a Service of GWV
- Diagnostic Radiology Physician
- Pittston, PA
- NPI 1104292960
Hospital
-
- General Acute Care Hospital
- Wilkes Barre, PA
- NPI 1174822068
-
- General Acute Care Hospital
- Wilkes Barre, PA
- NPI 1275620585
-
dba Geisinger HealthPlex CenterPoint
- General Acute Care Hospital
- Pittston, PA
- NPI 1316692585
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152057600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1710288000000",
"number": "1285665570",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 N ACADEMY AVE",
"city": "DANVILLE",
"state": "PA",
"postal_code": "178229800",
"telephone_number": "570-271-6144"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "175 S WILKES BARRE BLVD",
"city": "WILKES BARRE",
"state": "PA",
"postal_code": "187025040",
"telephone_number": "570-829-2621",
"fax_number": "570-823-4332"
}
],
"practiceLocations": [
{
"address_1": "4318 Mission Ave",
"address_purpose": "LOCATION",
"city": "Oceanside",
"state": "CA",
"postal_code": "920576541",
"country_code": "US",
"telephone_number": "760-901-5010",
"fax_number": "760-722-2204",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "NICKLES",
"first_name": "JULIE",
"middle_name": "PANDORA",
"name_prefix": "Dr.",
"credential": "D.O.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-05",
"last_updated": "2024-03-13",
"certification_date": "2024-03-13",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "PA",
"license": "OS004879L",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GEISINGER HEALTH PLAN",
"identifier": "22143",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "0459530",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAPITAL BLUE CROSS",
"identifier": "02713300",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "KHP CENTRAL",
"identifier": "2713300",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAPITAL BLUE SHIELD",
"identifier": "431452",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Wilkes Barre, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.