Coryn I Nicholls, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA19606 Issued in CA

Practice address

1601 Ygnacio Valley Rd
Walnut Creek, CA 94598-3122

Phone

(925) 947-5399

NPI assigned

Feb 7, 2008

Last updated

Dec 17, 2013By 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 names 1

• Coryn I Mayerson Former name

Medicare fee-for-service enrollment

Enrolled in CA

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

Physician Assistant

Education

Other, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Northbay Physicians Surgery Center, LLCGroup PAC ID 0042122244, 336 clinicians

Northbay Health Medical FoundationGroup PAC ID 3274010871, 207 clinicians

Urgent Care Plus Telehealth IncGroup PAC ID 0941630123, 27 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: coryn.nicholls.1@21754.direct.athenahealth.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.

• Northbay Health Medical Foundation

  dba NorthBay Health Medical Network

  • Internal Medicine Physician
  • Fairfield, CA
  • NPI 1760283527
  Medicare reassignment Care Compare group NPD
• Urgent Care Plus Telehealth Inc

  dba Telehealth & Urgent Care

  • Urgent Care Clinic/Center
  • Benicia, CA
  • NPI 1568082774
  Medicare reassignment Care Compare group NPD
• Northbay Healthcare Group

  dba dba NorthBay Medical Center

  • General Acute Care Hospital
  • Fairfield, CA
  • NPI 1821147786
  Medicare reassignment Care Compare group NPD (past)
• Cep America - California

  dba Vituity

  • Emergency Medicine Physician
  • San Francisco, CA
  • NPI 1023063542
  Medicare reassignment
• Cep America-California

  • Emergency Medicine Physician
  • Bakersfield, CA
  • NPI 1164218533
  NPD
• Cep America-California

  • Emergency Medicine Physician
  • Murrieta, CA
  • NPI 1588552848
  NPD
• Northbay Healthcare Group

  dba NorthBay VacaValley Hospital

  • Multi-Specialty Clinic/Center
  • Vacaville, CA
  • NPI 1760534713
  NPD
• Urgent Care Plus Telehealth Inc

  • Urgent Care Clinic/Center
  • Petaluma, CA
  • NPI 1447082045
  NPD
• Urgent Care Plus Telehealth Inc

  dba urgent care and telehealth

  • Urgent Care Clinic/Center
  • Sonoma, CA
  • NPI 1326759739
  NPD (past)

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

{
    "created_epoch": "1202342400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1387238400000",
    "number": "1487832739",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1601 YGNACIO VALLEY RD",
            "city": "WALNUT CREEK",
            "state": "CA",
            "postal_code": "945983122",
            "telephone_number": "925-947-5399"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1601 YGNACIO VALLEY RD",
            "city": "WALNUT CREEK",
            "state": "CA",
            "postal_code": "945983122",
            "telephone_number": "925-947-5399"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICHOLLS",
        "first_name": "CORYN",
        "middle_name": "I",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-02-07",
        "last_updated": "2013-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA19606",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CORYN",
            "last_name": "MAYERSON",
            "middle_name": "I",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Vivien An Nguyen, M.D.
• Yoko W Nguyen, PHARM.D.
• Tram Quynh Nhan, PHARMD
• Nic USA Inc (Happy Valley ICFDDH 2)
• Bryan Nicholas
• Shante Nichols-Lockwood, OTR/L
• Nicole Alexis Nichols
• Sarah Elizabeth Nichols, CNM
• Renee Nickerson, MA. EDS. PPSP
• Florinda Daquiz Nicolas, RNFA

• Physician Assistant in Walnut Creek, CA
• Providers in Walnut Creek, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2013; 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.