Timothy Robert Nickolaus, PA

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA60217353 Issued in WA

Practice address

875 Swift Blvd
Richland, WA 99352-3592

Phone

(509) 946-1654

Fax

(509) 943-5652

NPI assigned

May 24, 2011

Last updated

Jun 22, 2021By the provider in NPPES

Sex

Male

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 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in WA

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, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Kadlec Regional Medical CenterGroup PAC ID 9739098617, 402 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Kadlec Regional Medical Center Hospital, Richland, WA, CCN 500058
• Prosser Memorial Hospital Hospital, Prosser, WA, CCN 501312

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: tnickolaus1109147@wm.providencedirect.org

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.

• Kadlec Regional Medical Center

  • General Acute Care Hospital
  • Richland, WA
  • NPI 1972507580
  Medicare reassignment Care Compare group NPD (past)
• Kadlec Regional Medical Center

  • Plastic Surgery Physician
  • Richland, WA
  • NPI 1235471954
  NPD
• Kadlec Regional Medical Center

  dba Kadlec Regional Medical Center - Rehab Unit

  • Rehabilitation Hospital Unit
  • Richland, WA
  • NPI 1790319580
  NPD
• Medical Resources NW PC

  dba ActionEcho

  • Critical Care Medicine (Internal Medicine) Physician
  • Kennewick, WA
  • NPI 1336268333
  NPD (past)
• Tri-City Regional Surgery Center LLC

  • Ambulatory Surgical Clinic/Center
  • Richland, WA
  • NPI 1053418137
  NPD (past)

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

• Kadlec Regional Medical Center

  • General Acute Care Hospital
  • Richland, WA
  • NPI 1972507580
  Care Compare affiliation
• Prosser Public Hospital District of Benton County

  dba Prosser Memorial Health

  • Critical Access Hospital
  • Prosser, WA
  • NPI 1306897681
  Care Compare affiliation

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

{
    "created_epoch": "1306195200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624320000000",
    "number": "1518250554",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "560 GAGE BLVD",
            "address_2": "SUITE 203",
            "city": "RICHLAND",
            "state": "WA",
            "postal_code": "99352",
            "telephone_number": "509-942-3627",
            "fax_number": "509-942-2268"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "875 SWIFT BLVD",
            "city": "RICHLAND",
            "state": "WA",
            "postal_code": "993523592",
            "telephone_number": "509-946-1654",
            "fax_number": "509-943-5652"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1351 Fowler St",
            "address_purpose": "LOCATION",
            "city": "Richland",
            "state": "WA",
            "postal_code": "993524714",
            "country_code": "US",
            "telephone_number": "509-946-1654",
            "fax_number": "509-943-5652",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NICKOLAUS",
        "first_name": "TIMOTHY",
        "middle_name": "ROBERT",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-05-24",
        "last_updated": "2021-06-22",
        "certification_date": "2021-06-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "WA",
            "license": "PA60217353",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1518250554",
            "state": "WA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tnickolaus1109147@wm.providencedirect.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1351 Fowler St",
            "city": "Richland",
            "state": "WA",
            "country_code": "US",
            "postal_code": "993524714",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Luis Miguel Nicacio, D.C., C.C.S.P.
• Joe John Nicasio, R.C.
• Nicholas Smiley DDS MD PLLC
• Brooke Nicole Nickolaus, M.S., LMHC
• Casie Renee Nickolaus, M.S,PTA, ATC, AT/L
• Harprit Nijjer, D.C.
• Danielle Nipper, ARNP
• Julia Nkatha Nkanata, MHC
• Rosemarie Nocita
• Heidi Nolan, LMHC

• Medical Physician Assistant in Richland, WA
• Providers in Richland, WA by specialty
• Medical Physician Assistant in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 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.