Versatile Medicine PLLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

AZ26993 Issued in AZ

Legal business name

VERSATILE MEDICINE PLLC

Practice address

13055 W McDowell Rd
Suite E-106
Avondale, AZ 85392-6449

Phone

(623) 975-8400

Fax

(623) 935-2975

NPI assigned

Sep 20, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Kathleen A Nichols, M.D.NPI 1245241215

Title

Physician/General Manager

Phone

(623) 975-8400

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in AZ

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kathleen A Nichols, MD

  • Internal Medicine Physician
  • Avondale, AZ
  • NPI 1245241215
  Medicare reassignment Care Compare group NPD Authorized official
• Miranda Gruenberg, PA-C

  • Physician Assistant
  • Avondale, AZ
  • NPI 1841444734
  Medicare reassignment Care Compare group
• Terry E Hicks Woodbeck, MD

  • Internal Medicine Physician
  • Avondale, AZ
  • NPI 1891706875
  Medicare reassignment NPD

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1433721600000",
    "number": "1326145608",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13055 W MCDOWELL RD",
            "address_2": "SUITE E-106",
            "city": "AVONDALE",
            "state": "AZ",
            "postal_code": "853926449",
            "telephone_number": "623-975-8400",
            "fax_number": "623-935-2975"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13055 W MCDOWELL RD",
            "address_2": "SUITE E-106",
            "city": "AVONDALE",
            "state": "AZ",
            "postal_code": "853926449",
            "telephone_number": "623-975-8400",
            "fax_number": "623-935-2975"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VERSATILE MEDICINE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-20",
        "last_updated": "2015-06-08",
        "status": "A",
        "authorized_official_last_name": "NICHOLS",
        "authorized_official_first_name": "KATHLEEN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PHYSICIAN/GENERAL MANAGER",
        "authorized_official_telephone_number": "623-975-8400",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "AZ",
            "license": "AZ26993",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "AZ0761300",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "AZ0765500",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "517675",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "486581001",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ulissa Lianna Velasquez
• Brenda Venegas
• Barbara Sobarzo Ventura, LPC
• Esmeralda De la Rosa Verdy, CLD, CBE
• Sanjay Verma, MD
• Eva Vescio
• Vfel Services
• Larizza Viado, COTA
• Carmelita Victory
• Carin L Vierhout

• Internal Medicine Physician in Avondale, AZ
• Providers in Avondale, AZ by specialty
• Internal Medicine Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.