NPIMap

Individual provider Active NPI

Nicole M Gullick, M.D.

  • Family Medicine Physician
  • Tucson, AZ
National Provider Identifier
1295722718
Registry record updated Mar 30, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
23648 Issued in AZ
Practice address
6367 E Tanque Verde Road
Suite 200
Tucson, AZ 85715-3832
Phone
(520) 290-5888
Fax
(520) 290-5551
NPI assigned
Sep 29, 2005
Last updated
Mar 30, 2016By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 30, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 23648 AZ Primary
Family Medicine Physician 207Q00000X 16213 NV

Addresses

Primary practice location

6367 E Tanque Verde Road
Suite 200
Tucson, AZ 85715-3832

Mailing address

6367 E Tanque Verde Road
Suite 200
Tucson, AZ 85715-3832
Phone (520) 290-5888

Other identifiers 2

IdentifierTypeStateIssuer
1295722718MedicaidNV
401604-03MedicaidAZ

Other names 1

  • Dr. Nicole M Eckerstrom Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20151112000630 CA Practitioner - Family Practice 0749272573 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Santa Ynez Band of Mission IndiansGroup PAC ID 7618966516, 8 clinicians

Practice addresses (Care Compare)

90 Via Juana Rd
Santa Ynez, CA 93460-9679
Phone (805) 688-7070

PO Box
Suite 539
Santa Ynez, CA 93460

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
23648AZMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Santa Ynez Band of Mission Indians CurrentSince Nov 3, 2020 Accepting new patients
Hospitalists of Arizona, Inc Past Accepting new patients
Jorn Medical Services LLC Past Accepting new patients
Emergency Room Associates Limited Past Accepting new patients
Northwest Tucson Emergency Physicians, PC Past Accepting new patients

Locations

90 Via Juana Rd
Santa Ynez, CA 93460
Phone (805) 688-7070

680 Alamo Pintado Rd
Ste 202
Solvang, CA 93463
Phone (805) 688-3158

Interoperability endpoints

  • Direct secure messaging: nicole.gullick.p1@direct.sythc.nextgenshare.com

Organizations & group practices 5

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 3

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": "1127952000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1459296000000",
    "number": "1295722718",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6367 E TANQUE VERDE ROAD",
            "address_2": "SUITE 200",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857153832",
            "telephone_number": "520-290-5888",
            "fax_number": "520-290-5551"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6367 E TANQUE VERDE ROAD",
            "address_2": "SUITE 200",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857153832",
            "telephone_number": "520-290-5888",
            "fax_number": "520-290-5551"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GULLICK",
        "first_name": "NICOLE",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-09-29",
        "last_updated": "2016-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AZ",
            "license": "23648",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NV",
            "license": "16213",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1295722718",
            "state": "NV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "401604-03",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NICOLE",
            "last_name": "ECKERSTROM",
            "middle_name": "M",
            "prefix": "DR.",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Tucson, AZ

Sources for this page

Verify at the official NPI Registry.