Individual provider Active NPI

Thomas Louis Nickolas, MD

  • Endocrinology, Diabetes & Metabolism Physician
  • Saint Louis, MO
National Provider Identifier
1558438788
Registry record updated Apr 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X
License
2024049980 Issued in MO
Practice address
4921 Parkview PL
Div Im Bone and Mineral, Ste 5C
Saint Louis, MO 63110-1032
Phone
(314) 454-7775
Fax
(314) 996-3087
NPI assigned
Nov 30, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 17, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X 2024049980 MO
Endocrinology, Diabetes & Metabolism Physician 207RE0101X 2024049980 MO Primary

Addresses

Primary practice location

4921 Parkview PL
Div Im Bone and Mineral, Ste 5C
Saint Louis, MO 63110-1032

Mailing address

PO Box 7412011
Chicago, IL 60674-2011
Phone (314) 454-7775

Other identifiers 1

IdentifierTypeStateIssuer
200154745MedicaidMO

Electronic endpoints 1

TypeEndpointUseAffiliation
FHIR URL https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ Washington University

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, MO2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20031222000753 NY Practitioner - NephrologyPractitioner - Internal Medicine 0143128603 Reassigns benefits to 3 organizations
I20250410001850 MO Practitioner - EndocrinologyPractitioner - Nephrology 0143128603 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
EndocrinologyAlso: Nephrology
Education
University of Pittsburgh School of Medicine, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Washington UniversityGroup PAC ID 9830008770, 2,968 clinicians

Practice addresses (Care Compare)

4921 Parkview PL
Suite 5C
Saint Louis, MO 63110-1032
Phone (314) 454-7775

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as apm
Quality
85.32
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2024049980MOMDEndocrinology, Diabetes & Metabolism Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Trustees of Columbia University in the City of New York CurrentSince Jan 1, 2002 Accepting new patients
Trustees of Columbia University in the City of New York CurrentSince Jan 1, 2019 Accepting new patients
Trustees of Columbia University in the City of New York Current Accepting new patients
Trustees of Columbia University in the City of New York CurrentSince Sep 29, 2003 Accepting new patients
Washington University CurrentSince Mar 1, 2025 Accepting new patients
Trustees of Columbia University in the City of New York CurrentSince Sep 29, 2003 Accepting new patients
Washington University CurrentSince Mar 1, 2025 Accepting new patients
Washington University Past Accepting new patients

Locations

4921 Parkview Pl
Ste 13A
Saint Louis, MO 63110
Phone (314) 333-4100

4921 Parkview Pl
Ste 5C
Saint Louis, MO 63110
Phone (314) 286-2635

1234 S Kingshighway Blvd
Ste 1100
Saint Louis, MO 63110

8 Millstone Campus Dr
Saint Louis, MO 63146
Phone (314) 273-4375

630 W 168th St
Fl 12
New York, NY 10032
Phone (212) 305-6262

622 W 168th St
New York, NY 10032
Phone (212) 305-4931

161 Fort Washington Ave
New York, NY 10032
Phone (212) 305-8559

630 W 168th St
#4
New York, NY 10032
Phone (212) 305-6387

1150 Saint Nicholas Ave
New York, NY 10032
Phone (212) 304-5494

Interoperability endpoints

  • FHIR API: https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/R4/
  • FHIR API: https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/DSTU2/
  • Direct secure messaging: nln9001@direct.nyp.org

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 5

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": "1164844800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744848000000",
    "number": "1558438788",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7412011",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606742011",
            "telephone_number": "314-454-7775",
            "fax_number": "314-996-3087"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4921 PARKVIEW PL",
            "address_2": "DIV IM BONE AND MINERAL, STE 5C",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631101032",
            "telephone_number": "314-454-7775",
            "fax_number": "314-996-3087"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICKOLAS",
        "first_name": "THOMAS",
        "middle_name": "LOUIS",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-30",
        "last_updated": "2025-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "MO",
            "license": "2024049980",
            "primary": false
        },
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "MO",
            "license": "2024049980",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200154745",
            "state": "MO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "Y",
            "affiliationName": "Washington University",
            "address_1": "4921 Parkview Pl",
            "address_2": "Div IM Bone and Mineral, Ste 5C",
            "city": "Saint Louis",
            "state": "MO",
            "country_code": "US",
            "postal_code": "631101032",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.