NPIMap

Individual provider Active NPI

Jean Ellen Nichols

  • Physician Assistant
  • Wilmington, NC
National Provider Identifier
1285681692
Registry record updated Dec 15, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
102780 Issued in NC
Practice address
5115 Oleander Dr
Wilmington, NC 28403-7018
Phone
(910) 362-1011
Fax
(910) 362-1012
NPI assigned
May 30, 2006
Last updated
Dec 15, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 15, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 102780 NC Primary

Addresses

Primary practice location

5115 Oleander Dr
Wilmington, NC 28403-7018

Mailing address

5115 Oleander Dr
Wilmington, NC 28403-7018
Phone (910) 362-1011

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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
I20100318000949 NC Practitioner - Physician Assistant 5496880122 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

5115 Oleander Dr
Wilmington, NC 28403-7018
Phone (910) 362-1011

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
102780NCMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Wilmington Gastroenterology Associates,PA CurrentSince Oct 30, 2000 Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients

Locations

5115 Oleander Dr
Wilmington, NC 28403
Phone (910) 362-1011

Interoperability endpoints

  • Direct secure messaging: jnichols1690494@direct.novanthealth.org

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 9

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": "1148947200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702598400000",
    "number": "1285681692",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5115 OLEANDER DR",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284037018",
            "telephone_number": "910-362-1011",
            "fax_number": "910-362-1012"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5115 OLEANDER DR",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284037018",
            "telephone_number": "910-362-1011",
            "fax_number": "910-362-1012"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICHOLS",
        "first_name": "JEAN",
        "middle_name": "ELLEN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-30",
        "last_updated": "2023-12-15",
        "certification_date": "2023-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "102780",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilmington, NC

Sources for this page

Verify at the official NPI Registry.