William Alex Nicodemus, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

AP135915 Issued in TX

Practice address

2900 S Loop 256
Palestine, TX 75801-6958

Phone

(903) 731-1134

NPI assigned

Jan 4, 2018

Last updated

May 7, 2021By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Ut East Texas Urgent Care Centers, PLLCGroup PAC ID 7517385388, 33 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: wnicodemus914353@ahs.direct-ci.com

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.

• Ut East Texas Urgent Care Centers, PLLC

  • Urgent Care Clinic/Center
  • Canton, TX
  • NPI 1356974281
  Medicare reassignment Care Compare group NPD
• QV Urgent Care TX PLLC

  dba QuickVisit Urgent Care

  • Family Medicine Physician
  • Henderson, TX
  • NPI 1568098887
  Medicare reassignment NPD
• QV Urgent Care TX PLLC

  dba QuickVisit Urgent Care

  • Rural Health Clinic/Center
  • Madisonville, TX
  • NPI 1669198347
  NPD

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

{
    "created_epoch": "1515024000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620345600000",
    "number": "1427565068",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3120 VAN ZANT COUNTY ROAD 2318",
            "city": "CANTON",
            "state": "TX",
            "postal_code": "75103",
            "telephone_number": "903-479-3933",
            "fax_number": "903-479-9333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2900 S LOOP 256",
            "city": "PALESTINE",
            "state": "TX",
            "postal_code": "758016958",
            "telephone_number": "903-731-1134"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICODEMUS",
        "first_name": "WILLIAM",
        "middle_name": "ALEX",
        "credential": "FNP-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-01-04",
        "last_updated": "2021-05-07",
        "certification_date": "2021-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "AP135915",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Holly Lynn Nealy, LCSW
• Nephromed Associates PA
• Nerve Conduction Evaluation PC
• Neurology and Radiology Partners PA
• Jerry A Newton, M.D.
• Northland Hearing Center, Inc. (SoundWorks Hearing Centers)
• Court Bartlett Norton, M.D.
• Theodore D Novak III, DDS
• Leah C O'Dell, LPTA
• John O'Donnell, M.D.

• Family Nurse Practitioner in Palestine, TX
• Providers in Palestine, TX by specialty
• Family Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 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.