Michael Tysen Nickle, DO

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

TL.0009001 Issued in CO

Practice address

902 Lakeview Ave
Pueblo, CO 81004-3597

Phone

(719) 557-5872

Fax

(719) 557-4780

NPI assigned

Jun 14, 2021

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 CO

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 1

Specialty

Family Practice

Education

Rocky Vista University College of Osteopathic Med, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Valley-Wide Health Systems, Inc.Group PAC ID 5991609067, 42 clinicians

Rocky Vista Health Center LLCGroup PAC ID 1052443710, 18 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/8078/brand/1/csg/1/fhir/r4
• Direct secure messaging: michael.nickle.1@8078.direct.athenahealth.com
• Direct secure messaging: michaeltysen.nickle.p1@direct.vwhs.nextgenshare.com

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.

• Rocky Vista Health Center LLC

  • Family Medicine Physician
  • Englewood, CO
  • NPI 1366606709
  Medicare reassignment Care Compare group NPD
• Valley-Wide Health Systems, Inc

  • Federally Qualified Health Center (FQHC)
  • Alamosa, CO
  • NPI 1790998953
  Medicare reassignment Care Compare group NPD
• Valley-Wide Health Systems, Inc.

  • Federally Qualified Health Center (FQHC)
  • Alamosa, CO
  • NPI 1205652047
  NPD

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

{
    "created_epoch": "1623628800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624924800000",
    "number": "1417525601",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "902 LAKEVIEW AVE",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810043597",
            "telephone_number": "719-557-5872",
            "fax_number": "719-557-4780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "902 LAKEVIEW AVE",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810043597",
            "telephone_number": "719-557-5872",
            "fax_number": "719-557-4780"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICKLE",
        "first_name": "MICHAEL",
        "middle_name": "TYSEN",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-06-14",
        "last_updated": "2021-06-29",
        "certification_date": "2021-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "CO",
            "license": "TL.0009001",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CO",
            "license": "TL.0009001",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lindsay Newton
• Anh-Thu Qui Nguyen, M.D.
• Victoria Nguyen
• Tracey Renee Nicholls, L.AC
• Joshua Nichting, MD
• Emi Nider, PA-C
• Rachel Christine Niemet, M.D.
• Kevin A Nierode, D.D.S.
• Nikaos Counseling Colorado, PLLC
• Nile G Scott DDS PC

• Family Medicine Physician in Pueblo, CO
• Providers in Pueblo, CO by specialty
• Family Medicine Physician in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2021; 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.