NPIMap

Individual provider Active NPI

Edward R Nicholls, O.D.

  • Optometrist
  • American Fork, UT
National Provider Identifier
1376981175
Registry record updated Oct 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
8746430-9934 Issued in UT
Practice address
323 W State Rd Ste a
American Fork, UT 84003-5600
Phone
(801) 763-9898
Fax
(801) 763-7217
NPI assigned
Jun 13, 2013
Last updated
Oct 20, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 20, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 8746430-9934 UT Primary

Addresses

Primary practice location

323 W State Rd Ste a
American Fork, UT 84003-5600

Mailing address

323 W State Rd Ste a
American Fork, UT 84003-5600
Phone (801) 763-9898

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address enicholls593252@direct.med.utah.edu Direct University of Utah

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT
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
I20140204001847 UT Practitioner - Optometry 6901035351 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
University of Houston - College of Optometry, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
University of Utah Adult ServicesGroup PAC ID 0941525273, 1,758 clinicians

Practice addresses (Care Compare)

50 N Medical Dr
Salt Lake City, UT 84132-0100
Phone (801) 585-6387

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
89.77 of 100Reported as group
Quality
91.47
Promoting interoperability
100
Improvement activities
40
Cost
74.42

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
8746430-9934UTMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
University of Utah Adult Services Current Accepting new patients
University of Utah Adult Services CurrentSince Aug 1, 2022 Accepting new patients
University of Utah Adult Services CurrentSince Aug 1, 2022 Accepting new patients
Standard Optical Co Optometrist Past Accepting new patients
Bronson Lakeview Hospital Past Accepting new patients
Standard Optical Co Optometrist Past Accepting new patients
Standard Optical Co Optometrist Past Accepting new patients
Standard Optical Co Optometrist Past Accepting new patients
Standard Optical Co Optometrist Past Accepting new patients
Standard Optical Co Optometrist Past Accepting new patients
Standard Optical Co Optometrist Past Accepting new patients
Standard Optical Co Optometrist Past Accepting new patients

Locations

127 S 500 E
Ste 400B
Salt Lake City, UT 84102
Phone (801) 587-6478

50 N Medical Dr
Slc, UT 84132
Phone (801) 581-2292

Interoperability endpoints

  • Direct secure messaging: enicholls593252@direct.med.utah.edu

Organizations & group practices 12

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

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": "1371081600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666224000000",
    "number": "1376981175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "323 W STATE RD STE A",
            "city": "AMERICAN FORK",
            "state": "UT",
            "postal_code": "840035600",
            "telephone_number": "801-763-9898",
            "fax_number": "801-763-7217"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "323 W STATE RD STE A",
            "city": "AMERICAN FORK",
            "state": "UT",
            "postal_code": "840035600",
            "telephone_number": "801-763-9898",
            "fax_number": "801-763-7217"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICHOLLS",
        "first_name": "EDWARD",
        "middle_name": "R",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-06-13",
        "last_updated": "2022-10-20",
        "certification_date": "2022-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "UT",
            "license": "8746430-9934",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "enicholls593252@direct.med.utah.edu",
            "affiliation": "Y",
            "affiliationName": "University of Utah",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "50 N Medical Dr",
            "city": "Salt Lake City",
            "state": "UT",
            "country_code": "US",
            "postal_code": "841320001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in American Fork, UT

Sources for this page

Verify at the official NPI Registry.