Michael Nicksic, MD

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

License

0116038831 Issued in VA

Practice address

1215 Lee St Box 800377
Charlottesville, VA 22908-0816

Phone

(434) 924-9400

Fax

(434) 243-6731

NPI assigned

Jun 7, 2017

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in TN, VA2 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

Diagnostic Radiology

Education

University of Louisville School of Medicine, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Blue Ridge Radiology PCGroup PAC ID 7416860473, 77 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Wellmont Holston Valley Medical Center Hospital, Kingsport, TN, CCN 440017
• Wellmont Bristol Regional Medical Center Hospital, Bristol, TN, CCN 440012
• Johnson City Medical Center Hospital, Johnson City, TN, CCN 440063
• Greeneville Community Hospital Hospital, Greeneville, TN, CCN 440050
• Johnston Memorial Hospital Hospital, Abingdon, VA, CCN 490053

Medicare enrollment (NPD)

Enrolled

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.

• Blue Ridge Radiology, P.C.

  • Diagnostic Radiology Physician
  • Bristol, TN
  • NPI 1881687689

  VA

  Medicare reassignment Care Compare group NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Johnston Memorial Hospital, Inc

  • General Acute Care Hospital
  • Abingdon, VA
  • NPI 1104812684
  Care Compare affiliation
• Mountain States Health Alliance

  • Psychiatric Hospital Unit
  • Johnson City, TN
  • NPI 1023434339
  Care Compare affiliation
• Mountain States Health Alliance

  • Psychiatric Hospital Unit
  • Johnson City, TN
  • NPI 1962915652
  Care Compare affiliation
• Mountain States Health Alliance

  • General Acute Care Hospital
  • Johnson City, TN
  • NPI 1972606465
  Care Compare affiliation
• Takoma Regional Hospital Inc

  • General Acute Care Hospital
  • Greeneville, TN
  • NPI 1699819003
  Care Compare affiliation
• Wellmont Health System

  • General Acute Care Hospital
  • Bristol, TN
  • NPI 1124058615
  Care Compare affiliation
• Wellmont Health System

  • General Acute Care Hospital
  • Kingsport, TN
  • NPI 1487690400
  Care Compare affiliation

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

{
    "created_epoch": "1496793600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718409600000",
    "number": "1346779907",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1215 LEE ST BOX 800377",
            "city": "CHARLOTTESVILLE",
            "state": "VA",
            "postal_code": "229080816",
            "telephone_number": "434-924-9400",
            "fax_number": "434-243-6731"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1215 LEE ST BOX 800377",
            "city": "CHARLOTTESVILLE",
            "state": "VA",
            "postal_code": "229080816",
            "telephone_number": "434-924-9400",
            "fax_number": "434-243-6731"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "395 W 12th Ave",
            "address_purpose": "LOCATION",
            "city": "Columbus",
            "state": "OH",
            "postal_code": "432101267",
            "country_code": "US",
            "telephone_number": "614-293-8315",
            "fax_number": "614-293-6935",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NICKSIC",
        "first_name": "MICHAEL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-06-07",
        "last_updated": "2024-06-15",
        "certification_date": "2024-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "OH",
            "license": "35.140897",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "VA",
            "license": "0116038831",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Thedra E Nichols, FNP
• Brandi T. Nicholson, MD
• Demetrious Tra Nicholson
• Kendra L Nicholson, OT
• Arash Nickkholgh, M.D.
• Manal Nicolas-Jilwan, M.D.
• Nicole Beasley, PHD
• Darlene Nicoletti, DDS
• Barbara L. Nidiffer, OT/L
• Dinah Hays Nieburg, PH.D.

• Student in an Organized Health Care Education/Training Program in Charlottesville, VA
• Providers in Charlottesville, VA by specialty
• Student in an Organized Health Care Education/Training Program in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2024; 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.