Active NPI
Christopher Nicholas, MD
- Family Medicine Physician
- Cannon Air Force Base, NM
National Provider Identifier
1427787696
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 36090
- Practice address
- 27TH Somg 224 W D. L. Ingram Avenue, BLDG. 1408
Cannon Air Force Base, NM 88103-0000 - Phone
- (402) 559-7249
- NPI assigned
- Jun 5, 2022
- Last updated
- Aug 5, 2025
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 36090 | NE | Primary |
Addresses
Primary practice location
27TH Somg 224 W D. L. Ingram Avenue, BLDG. 1408
Cannon Air Force Base, NM 88103-0000
Mailing address
27TH Somg 224 W D. L. Ingram Avenue, BLDG. 1408
Cannon Air Force Base, NM 88103
Phone (575) 784-2377
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NE
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20221005002595 | NE | Order and Referring Only - Family Practice | 2062898679 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 36090 | NE | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1654387200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1754352000000",
"number": "1427787696",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "27TH SOMG 224 W D. L. INGRAM AVENUE, BLDG. 1408",
"city": "CANNON AIR FORCE BASE",
"state": "NM",
"postal_code": "88103",
"telephone_number": "575-784-2377",
"fax_number": "575-784-2308"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "27TH SOMG 224 W D. L. INGRAM AVENUE, BLDG. 1408",
"city": "CANNON AIR FORCE BASE",
"state": "NM",
"postal_code": "881030000",
"telephone_number": "402-559-7249"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NICHOLAS",
"first_name": "CHRISTOPHER",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-06-05",
"last_updated": "2025-08-05",
"certification_date": "2025-07-31",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "NE",
"license": "36090",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cannon Air Force Base, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2025; 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.