Active NPI
Andreas C. Nikolaidis, M.D.
- Pediatrics Physician
- Porter, TX
National Provider Identifier
1528021888
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- L3042
- Practice address
- 24375 FM 1314 Rd
Porter, TX 77365-4205 - Phone
- (281) 354-5663
- Fax
- (281) 354-1995
- NPI assigned
- Apr 8, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | L3042 | TX | Primary |
Addresses
Primary practice location
24375 FM 1314 Rd
Porter, TX 77365-4205
Mailing address
24375 FM 1314 Rd
Porter, TX 77365-4205
Phone (281) 354-5663
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0074HX | Other | BLUECROSS BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| L3042 | TX | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1144454400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1528021888",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "24375 FM 1314 RD",
"city": "PORTER",
"state": "TX",
"postal_code": "773654205",
"telephone_number": "281-354-5663",
"fax_number": "281-354-1995"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "24375 FM 1314 RD",
"city": "PORTER",
"state": "TX",
"postal_code": "773654205",
"telephone_number": "281-354-5663",
"fax_number": "281-354-1995"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NIKOLAIDIS",
"first_name": "ANDREAS",
"middle_name": "C.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-04-08",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "TX",
"license": "L3042",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUECROSS BLUE SHIELD",
"identifier": "0074HX",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Porter, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.