Nicole Sunderland Anderson, MD

Primary specialty

Radiation Oncology PhysicianTaxonomy code 2085R0001X

License

ME 111558 Issued in FL

Practice address

1235 San Marco Blvd
Suite 100
Jacksonville, FL 32207-8554

Phone

(904) 202-7020

Fax

(904) 202-7029

NPI assigned

Nov 29, 2007

Last updated

Jul 31, 2012By the provider in NPPES

Sex

Female

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 4

Medicare fee-for-service enrollment

Enrolled in SC

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

Radiation Oncology

Education

Warren Alpert Medical School of Brown University, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Georgetown Radiation Therapy CenterGroup PAC ID 3678473477, 2 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Tidelands Georgetown Memorial Hospital Hospital, Georgetown, SC, CCN 420020
• Tidelands Waccamaw Community Hospital Hospital, Murrells Inlet, SC, CCN 420098

Merit-based Incentive Payment System (MIPS)

Final score

75 of 100Reported as individual

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Georgetown Radiation Therapy Center

  • Radiation Oncology Physician
  • Georgetown, SC
  • NPI 1053304675
  Medicare reassignment Care Compare group NPD
• Integrated Community Oncology Network LLC

  dba Florida Radiation Oncology Group

  • Radiation Oncology Physician
  • Jacksonville, FL
  • NPI 1043230402
  NPD (past)
• Radiosurgery Center of Rhode Island LLC

  • Radiation Oncology Physician
  • Providence, RI
  • NPI 1578726261
  NPD (past)
• Women & Infants Hospital of Rhode Island

  • General Acute Care Hospital
  • Providence, RI
  • NPI 1447233788
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Georgetown Memorial Hospital

  dba Tidelands Health Skilled Care

  • Skilled Nursing Facility
  • Georgetown, SC
  • NPI 1881307056

  Hospital

  Care Compare affiliation
• Georgetown Memorial Hospital

  dba Tidelands Georgetown Memorial Hospital

  • General Acute Care Hospital
  • Georgetown, SC
  • NPI 1982604021
  Care Compare affiliation
• Waccamaw Community Hospital

  dba Tidelands Waccamaw Community Hospital

  • General Acute Care Hospital
  • Murrells Inlet, SC
  • NPI 1972503910
  Care Compare affiliation

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

{
    "created_epoch": "1196294400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1343692800000",
    "number": "1437331733",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19675",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322459675",
            "telephone_number": "904-309-8680",
            "fax_number": "904-345-5841"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1235 SAN MARCO BLVD",
            "address_2": "SUITE 100",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322078554",
            "telephone_number": "904-202-7020",
            "fax_number": "904-202-7029"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "NICOLE",
        "middle_name": "SUNDERLAND",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-11-29",
        "last_updated": "2012-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Radiation Oncology",
            "state": "FL",
            "license": "ME 111558",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003120545A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004305000",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "14J0N",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AVMED",
            "identifier": "351861",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lindsey Anderson
• Lisa Anderson, P.T.
• Melody Anderson
• Michael Lee Anderson, APRN
• Michelle Anderson, MS, LMHC
• Payton Elizabeth Anderson
• Robert M Anderson, HAS
• Samantha Anderson
• Sara Rebecca Anderson, LMHC
• Shaquila Anderson

• Radiation Oncology Physician in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Radiation Oncology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2012; 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.