Individual provider Active NPI

Linda S Nikolakopoulos, M.S, R.D, L.D.N

  • Registered Dietitian
  • Lynn, MA
National Provider Identifier
1427264696
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
License
1738 Issued in MA
Practice address
19 Bridle Path Rd
Lynn, MA 01904-1260
Phone
(617) 257-3467
NPI assigned
May 15, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Dietitian 133V00000X 1738 MA Primary

Addresses

Primary practice location

19 Bridle Path Rd
Lynn, MA 01904-1260

Mailing address

19 Bridle Path Rd
Lynn, MA 01904-1260
Phone (617) 257-3467

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120508000467 MA Practitioner - Registered Dietitian Or Nutrition Professional 3274632823 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Registered Dietitian Or Nutrition Professional
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Internal Medicine Physicians of the North Shore LLCGroup PAC ID 5193798635, 5 clinicians

Practice addresses (Care Compare)

27 Centennial Dr
Peabody, MA 01960-7901
Phone (978) 531-7677

85 Constitution LN
Suite 300a
Danvers, MA 01923-3694
Phone (617) 257-3467

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
1738MAMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Internal Medicine Physicians of the North Shore LLC CurrentSince May 21, 2022 Accepting new patients
North Shore Nurse Practitioner Associates, LLC PastSince Oct 2, 2020 Accepting new patients

Locations

27 Centennial Dr
Peabody, MA 01960
Phone (978) 531-7677

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1179187200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1427264696",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19 BRIDLE PATH RD",
            "city": "LYNN",
            "state": "MA",
            "postal_code": "019041260",
            "telephone_number": "617-257-3467"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19 BRIDLE PATH RD",
            "city": "LYNN",
            "state": "MA",
            "postal_code": "019041260",
            "telephone_number": "617-257-3467"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NIKOLAKOPOULOS",
        "first_name": "LINDA",
        "middle_name": "S",
        "credential": "M.S, R.D, L.D.N",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-05-15",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "MA",
            "license": "1738",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lynn, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.