Mike Nichols, M.D.

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

G49792 Issued in CA

Practice address

14583 Big Basin Way
#2B
Saratoga, CA 95070-6072

Phone

(408) 647-2130

Fax

(888) 362-6713

NPI assigned

Jun 30, 2008

Last updated

May 14, 2009By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1214784000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1242259200000",
    "number": "1285896373",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14583 BIG BASIN WAY",
            "address_2": "#2B",
            "city": "SARATOGA",
            "state": "CA",
            "postal_code": "950706072",
            "telephone_number": "408-647-2130",
            "fax_number": "888-362-6713"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14583 BIG BASIN WAY",
            "address_2": "#2B",
            "city": "SARATOGA",
            "state": "CA",
            "postal_code": "950706072",
            "telephone_number": "408-647-2130",
            "fax_number": "888-362-6713"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICHOLS",
        "first_name": "MIKE",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-06-30",
        "last_updated": "2009-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "CA",
            "license": "G49792",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Crystal Adilene Nunez, ATC
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• Shawnessy Patrick O'Dell, PSY.D.
• Lindsey Marie O'Farriell, DDS

• General Practice Physician in Saratoga, CA
• Providers in Saratoga, CA by specialty
• General Practice Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2009; 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.

Verify at the official NPI Registry.