Shamolie Nicole Wyckoff, M.D.

Primary specialty

Pain Medicine PhysicianTaxonomy code 208VP0000X

License

48072 Issued in TN

Practice address

5651 Frist Blvd
Ste 712
Hermitage, TN 37076-2054

Phone

(615) 872-9966

Fax

(615) 872-9967

NPI assigned

Jan 31, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in GA, NC2 enrollments

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 2

Specialty

Physical Medicine and RehabilitationAlso: Pain Management

Education

Other, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Carolinas Physicians Network IncGroup PAC ID 3375449655, shared by 56 NPIs, 2,324 clinicians

The Southeast Permanente Medical GroupGroup PAC ID 6204829013, 823 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• The Southeast Permanente Medical Group

  • Internal Medicine Physician
  • Atlanta, GA
  • NPI 1245266956
  Medicare reassignment Care Compare group NPD
• Carolinas Medical Center

  • Obstetrics & Gynecology Physician
  • Charlotte, NC
  • NPI 1275774333
  Medicare reassignment
• Carolinas Physicians Network Inc

  • Orthopaedic Surgery Physician
  • Charlotte, NC
  • NPI 1437607686
  Medicare reassignment
• Carolinas Physicians Network Inc

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Charlotte, NC
  • NPI 1477878890
  Medicare reassignment
• Carolinas Medical Center

  • Surgical Critical Care Physician
  • Charlotte, NC
  • NPI 1699979732
  NPD
• Carolinas Medical Center

  • Community/Retail Pharmacy
  • Charlotte, NC
  • NPI 1982710554
  NPD
• Carolinas Physicians Network Inc

  • Sports Medicine (Family Medicine) Physician
  • Concord, NC
  • NPI 1295967586
  NPD
• Carolinas Physicians Network Inc

  • Sports Medicine (Family Medicine) Physician
  • Charlotte, NC
  • NPI 1386991297
  NPD
• Carolinas Physicians Network Inc

  • Endocrinology, Diabetes & Metabolism Physician
  • Charlotte, NC
  • NPI 1437038544
  NPD
• Hope Health & Wellness Inc

  • Multi-Specialty Clinic/Center
  • West Palm Beach, FL
  • NPI 1437347176
  NPD (past)
• Hope Health and Wellness Inc

  • Multi-Specialty Clinic/Center
  • Palm Beach Gardens, FL
  • NPI 1497920771
  NPD (past)

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

{
    "created_epoch": "1170201600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641772800000",
    "number": "1295872216",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15180 OLD HICKORY BLVD",
            "address_2": "#417",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372116503"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5651 FRIST BLVD",
            "address_2": "STE 712",
            "city": "HERMITAGE",
            "state": "TN",
            "postal_code": "370762054",
            "telephone_number": "615-872-9966",
            "fax_number": "615-872-9967"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WYCKOFF",
        "first_name": "SHAMOLIE",
        "middle_name": "NICOLE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-31",
        "last_updated": "2022-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "MD",
            "license": "P20277",
            "primary": false
        },
        {
            "code": "208VP0000X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Pain Medicine",
            "state": "TN",
            "license": "48072",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepiceast.kp.org:14430/Interconnect-prodgam/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "3650 Steve Reynolds Blvd",
            "city": "Duluth",
            "state": "GA",
            "country_code": "US",
            "postal_code": "300964506",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Tommy Albert Wood, MD
• Donald Woods, DDS
• Manako Woods
• Tomikia Woods
• Christopher Scott Wren, PHARMD
• Natalie Yang, PHARMD
• Anna Catherine Yates, MD
• Abigail Yazbak
• Aaron Leo Yazdian, MD
• Joshua Olsen Young, M.D.

• Pain Medicine Physician in Hermitage, TN
• Providers in Hermitage, TN by specialty
• Pain Medicine Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 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.
• 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.

Verify at the official NPI Registry.