NPIMap

Individual provider Active NPI

Timothy A Nicholls, MD

  • Internal Medicine Physician
  • Shreveport, LA
National Provider Identifier
1457314015
Registry record updated Nov 15, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
018515 Issued in LA
Practice address
2551 Greenwood Rd
Suite 410
Shreveport, LA 71103-3981
Phone
(318) 621-2929
NPI assigned
Apr 6, 2006
Last updated
Nov 15, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 15, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 018515 LA Primary

Addresses

Primary practice location

2551 Greenwood Rd
Suite 410
Shreveport, LA 71103-3981

Mailing address

2551 Greenwood Rd
Suite 410
Shreveport, LA 71103-3981
Phone (318) 621-2929

Other identifiers 1

IdentifierTypeStateIssuer
1917745MedicaidLA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20061017000397 LA Practitioner - Internal Medicine 4486650371 Reassigns benefits to 1 organization
Practice locations: Shreveport, LA

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Louisiana State University School of Medicine in Shreveport, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
WK Tri-State Medical ClinicGroup PAC ID 0143225128, 13 clinicians

Practice addresses (Care Compare)

2551 Greenwood Rd
Suite 410
Shreveport, LA 71103-3989
Phone (318) 621-2929

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
91.53 of 100Reported as apm
Quality
81.42
Promoting interoperability
94.6
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
018515LAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
WK Tri-State Medical Clinic Internal Medicine CurrentSince Jul 1, 2006 Accepting new patients

Locations

2551 Greenwood Rd
Ste 410
Shreveport, LA 71103
Phone (318) 621-2929

Interoperability endpoints

  • Direct secure messaging: tnicholls@direct.wkhs.com

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Progressive Care CenterShreveport, LA, CCN 195136 Skilled nursing facility Adp of the SNF Sep 19, 2025

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 1

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.

Hospital & facility affiliations 12

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

NPI Registry JSON

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

{
    "created_epoch": "1144281600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1195084800000",
    "number": "1457314015",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2551 GREENWOOD RD",
            "address_2": "SUITE 410",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711033981",
            "telephone_number": "318-621-2929"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2551 GREENWOOD RD",
            "address_2": "SUITE 410",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711033981",
            "telephone_number": "318-621-2929"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICHOLLS",
        "first_name": "TIMOTHY",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-06",
        "last_updated": "2007-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "LA",
            "license": "018515",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1917745",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Shreveport, LA

Sources for this page

Verify at the official NPI Registry.