NPIMap

Individual provider Active NPI

Nikki Hannon, PAC

  • Physician Assistant
  • Sparks, NV
National Provider Identifier
1346900487
Registry record updated Sep 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA2879 Issued in NV
Practice address
780 Vista Blvd Ste 100
Sparks, NV 89434-6677
Phone
(775) 348-8800
Fax
(833) 687-1419
NPI assigned
Dec 29, 2021
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 27, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA2879 NV Primary

Addresses

Primary practice location

780 Vista Blvd Ste 100
Sparks, NV 89434-6677

Mailing address

5310 Kietzke LN Ste 104
Reno, NV 89511-2043
Phone (775) 348-8800

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
I20231026001955 NV Practitioner - Physician Assistant 1254787294 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
James J Lynch M D LTDGroup PAC ID 9133188626, 81 clinicians
Custom Physical Therapy Limited PartnershipGroup PAC ID 1355252842, shared by 2 NPIs, 76 clinicians

Practice addresses (Care Compare)

10539 Professional Cir
Suite 201
Reno, NV 89521-3858
Phone (775) 793-6190

1470 Medical Pkwy
Suite 220
Carson City, NV 89703-4647
Phone (775) 348-8800

440 E Golden Valley Rd
Suite Aandb
Reno, NV 89506-5722
Phone (775) 360-3000

7700 Rancharrah Pkwy
Suite 100
Reno, NV 89511-7659
Phone (775) 348-8800

780 Vista Blvd
Suite 100
Sparks, NV 89434-6677
Phone (775) 348-8800

Hospital & facility affiliations

  • Centerwell Home Health Home health agency, Reno, NV, CCN 297022
  • Renown South Meadows Medical Center Hospital, Reno, NV, CCN 290049
  • Renown Regional Medical Center Hospital, Reno, NV, CCN 290001
  • Northern Nevada Medical Center Hospital, Sparks, NV, CCN 290032
  • Incline Village Community Hospital Hospital, Incline Village, NV, CCN 291301
  • Banner Churchill Community Hospital Hospital, Fallon, NV, CCN 291313

Merit-based Incentive Payment System (MIPS)

Final score
90.71 of 100Reported as apm
Quality
81.42
Promoting interoperability
100
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
90.71 of 100Reported as apm
Quality
81.42
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA2879NVMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
James J Lynch MD LTD CurrentSince May 1, 2024 Accepting new patients
James J Lynch M D LTD CurrentSince May 1, 2024 Accepting new patients

Locations

1470 Medical Pkwy
Ste 220
Carson City, NV 89703

10539 Professional Cir
Ste 201
Reno, NV 89521
Phone (775) 674-5632

9480 Double Diamond Pkwy
Ste 100
Reno, NV 89521
Phone (775) 329-3100

5310 Kietzke Ln
Ste 104
Reno, NV 89511

9990 Double R Blvd
Ste 200
Reno, NV 89521
Phone (753) 488-8008

780 Vista Blvd
Ste 100
Sparks, NV 89434
Phone (753) 348-8800

780 Vista Blvd
Ste 101
Sparks, NV 89434

Interoperability endpoints

  • Direct secure messaging: nikki.hannon.1@22724.direct.athenahealth.com

Organizations & group practices 2

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.

Hospital & facility affiliations 12

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

NPI Registry JSON

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

{
    "created_epoch": "1640736000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727395200000",
    "number": "1346900487",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5310 KIETZKE LN STE 104",
            "city": "RENO",
            "state": "NV",
            "postal_code": "895112043",
            "telephone_number": "775-348-8800",
            "fax_number": "833-687-1419"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "780 VISTA BLVD STE 100",
            "city": "SPARKS",
            "state": "NV",
            "postal_code": "894346677",
            "telephone_number": "775-348-8800",
            "fax_number": "833-687-1419"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HANNON",
        "first_name": "NIKKI",
        "credential": "PAC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-12-29",
        "last_updated": "2024-09-27",
        "certification_date": "2024-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NV",
            "license": "PA2879",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sparks, NV

Sources for this page

Verify at the official NPI Registry.