Gary S. Nickerson, D.D.S.

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

12009939A Issued in IN

Practice address

2833 Lincoln St
Suite 1
Highland, IN 46322-1924

Phone

(219) 838-2007

Fax

(219) 972-6267

NPI assigned

Jul 13, 2006

Last updated

Jul 9, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Enrolled in IN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

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.

• Highland Pediatric Dentistry, P.C.

  • Pediatric Dentistry
  • Highland, IN
  • NPI 1790359370
  NPD (past)
• Pediatric Dentistry of Northwest Indiana PC

  • Pediatric Dentistry
  • Highland, IN
  • NPI 1861417818
  NPD (past)

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

{
    "created_epoch": "1152748800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1386669257",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8330 W 145TH PL",
            "city": "ORLAND PARK",
            "state": "IL",
            "postal_code": "604622867",
            "telephone_number": "708-349-8677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2833 LINCOLN ST",
            "address_2": "SUITE 1",
            "city": "HIGHLAND",
            "state": "IN",
            "postal_code": "463221924",
            "telephone_number": "219-838-2007",
            "fax_number": "219-972-6267"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICKERSON",
        "first_name": "GARY",
        "middle_name": "S.",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-13",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "IN",
            "license": "12009939A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "130765",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "755187",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Natural Wellness LLC
• Katie Naughton
• Iwona Navarro
• Michael Nestlehut
• Rebecca Lynn Newenhouse, MA, BCBA
• Nicole Annette Nicksic
• Noble Home Health Care LLC
• Northwest Indiana Id Associates PC
• Northwest Indiana Podiatry Clinic, LLC
• Northwest Indiana Therapy Center, LLC

• Pediatric Dentistry in Highland, IN
• Providers in Highland, IN by specialty
• Pediatric Dentistry in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.