Jeffrey Gerard Nicholson, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

904-023 Issued in WI

Practice address

19035 W Capitol Dr
Suite 101
Brookfield, WI 53045-2755

Phone

(262) 754-1421

Fax

(262) 754-3760

NPI assigned

Jan 25, 2006

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

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Physician Associates of Wisconsin, SC

  • Clinic/Center
  • Milwaukee, WI
  • NPI 1437472172
  NPD Authorized official
• Emergency Medicine Associates of Madison, SC

  • Emergency Medicine Physician
  • Madison, WI
  • NPI 1235119769
  NPD (past)

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

{
    "created_epoch": "1138147200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1502928000000",
    "number": "1326018904",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7033 WELLAUER DR",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532133734",
            "telephone_number": "414-517-6915",
            "fax_number": "414-877-1700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19035 W CAPITOL DR",
            "address_2": "SUITE 101",
            "city": "BROOKFIELD",
            "state": "WI",
            "postal_code": "530452755",
            "telephone_number": "262-754-1421",
            "fax_number": "262-754-3760"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICHOLSON",
        "first_name": "JEFFREY",
        "middle_name": "GERARD",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-01-25",
        "last_updated": "2017-08-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "904-023",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "42981400",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDCARE PTAN",
            "identifier": "WI1826001",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Newport Pathology
• Bradley NG, DPT
• Erika Nguyen
• Thu Nguyen
• Tammy Kay Nicholas, P.T.
• Michele Nickels, NMD, LAC
• Charles G Niebler, OD
• Christina W Nielsen, OTR
• Paige Nierman, SLP
• Thomas M Nigro Jr., CRNA

• Physician Assistant in Brookfield, WI
• Providers in Brookfield, WI by specialty
• Physician Assistant in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.