NPIMap

Individual provider Active NPI

Patrick Ticman, MD

  • Internal Medicine Physician
  • Las Vegas, NV
National Provider Identifier
1306935473
Registry record updated Nov 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
12055 Issued in NV
Practice address
4475 S Eastern Ave
Las Vegas, NV 89119
Phone
(702) 737-1880
Fax
(702) 650-2458
NPI assigned
Oct 12, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 19, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 12055 NV Primary

Addresses

Primary practice location

4475 S Eastern Ave
Las Vegas, NV 89119

Mailing address

PO Box 35380
Las Vegas, NV 89133-5380
Phone (702) 877-5199

Other identifiers 3

IdentifierTypeStateIssuer
100511025MedicaidNV
100511024MedicaidNV
1306935473MedicaidNV

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV
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
I20070119000426 NV Practitioner - Internal Medicine 3779584602 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Optum Medical Group II Rhodes P CGroup PAC ID 4981687779, 296 clinicians

Practice addresses (Care Compare)

4475 S Eastern Ave
Las Vegas, NV 89119-7826
Phone (702) 579-3253

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
12055NVMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Optum Medical Group Rhodes P C CurrentSince Jun 3, 2019 Accepting new patients
Optum Medical Group II Rhodes P C Internal Medicine CurrentSince Jun 3, 2019 Accepting new patients
Southwest Medical Associates, Inc Internal Medicine CurrentSince Dec 11, 2006 Accepting new patients
Spring Valley Medical Center Past Accepting new patients
Fairbanks Clinic Inc PastSince Dec 13, 2020 Accepting new patients
Dignity Health Past Accepting new patients
De Craig Ranch, LLC Past Accepting new patients
Southern Hills Medical Center, LLC Past Accepting new patients
Summerlin Hospital Medical Center L L C Past Accepting new patients
De Craig Ranch, LLC Past Accepting new patients
Linda L. Johnson MD, LTD Past Accepting new patients
Henderson Hospital Past Accepting new patients
Sunrise Hospital and Medical Center, LLC Past Accepting new patients
North Vista Hospital LLC Past Accepting new patients
Sunrise Mountainview Hospital, Inc. Past Accepting new patients
Dignity Health Past Accepting new patients

Locations

300 E Lake Mead Pkwy
Henderson, NV 89015
Phone (702) 435-4301

420 N Nellis Blvd
Las Vegas, NV 89110
Phone (702) 339-5710

4475 S Eastern Ave
Las Vegas, NV 89119
Phone (702) 669-5811

2316 W Charleston Blvd
Las Vegas, NV 89102
Phone (702) 877-8330

Interoperability endpoints

  • Direct secure messaging: pticman119451@westdirect.optum.com
  • FHIR API: https://api.platform.athenahealth.com/1566/brand/2/csg/41/fhir/r4

Organizations & group practices 16

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.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1160611200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731974400000",
    "number": "1306935473",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 35380",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891335380",
            "telephone_number": "702-877-5199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4475 S EASTERN AVE",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "89119",
            "telephone_number": "702-737-1880",
            "fax_number": "702-650-2458"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TICMAN",
        "first_name": "PATRICK",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-12",
        "last_updated": "2024-11-19",
        "certification_date": "2024-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NV",
            "license": "12055",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100511025",
            "state": "NV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100511024",
            "state": "NV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1306935473",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

Verify at the official NPI Registry.