Active NPI
Samuel Aaron Nickell, MD
- Psychiatry Physician
- Albuquerque, NM
National Provider Identifier
1306010400
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- MD 2012-0434
- Practice address
- 4813 Haines Ave NE
Albuquerque, NM 87110-5008 - Phone
- (505) 508-2075
- NPI assigned
- Apr 18, 2008
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | MD 2012-0434 | NM | Primary |
Addresses
Primary practice location
4813 Haines Ave NE
Albuquerque, NM 87110-5008
Mailing address
2400 Tucker Blvd NE
Albuquerque, NM 87131-0001
Phone (505) 272-2800
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD 2012-0434 | NM | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1208476800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1341187200000",
"number": "1306010400",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2400 TUCKER BLVD NE",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871310001",
"telephone_number": "505-272-2800"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4813 HAINES AVE NE",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871105008",
"telephone_number": "505-508-2075"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NICKELL",
"first_name": "SAMUEL",
"middle_name": "AARON",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-04-18",
"last_updated": "2012-07-02",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "NM",
"license": "MD 2012-0434",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Albuquerque, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.