Nikom Udomphonkul, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

A34194 Issued in CA

Practice address

284 Spruce St
Gridley, CA 95948-2216

Phone

(530) 846-9035

Fax

(530) 846-9075

NPI assigned

Oct 24, 2006

Last updated

Feb 23, 2016By 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

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Orchard Hospital

  • Critical Access Hospital
  • Gridley, CA
  • NPI 1477522019
  Medicare reassignment NPD
• Nikom Udom Medical Clinic

  • Internal Medicine Physician
  • Gridley, CA
  • NPI 1992922942
  Authorized official Same address or phone
• Orchard Hospital

  • Medicare Defined Swing Bed Hospital Unit
  • Gridley, CA
  • NPI 1295882819
  NPD

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

{
    "created_epoch": "1161648000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1456185600000",
    "number": "1598849192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 947",
            "city": "GRIDLEY",
            "state": "CA",
            "postal_code": "95948",
            "telephone_number": "530-846-3604",
            "fax_number": "530-846-2108"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "284 SPRUCE ST",
            "city": "GRIDLEY",
            "state": "CA",
            "postal_code": "959482216",
            "telephone_number": "530-846-9035",
            "fax_number": "530-846-9075"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "UDOMPHONKUL",
        "first_name": "NIKOM",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-24",
        "last_updated": "2016-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A34194",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A34194",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Lyndi Wallace
• Cody James Walsh

• Internal Medicine Physician in Gridley, CA
• Providers in Gridley, CA by specialty
• Internal Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2016; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.