Pamela Elaine Nickson, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

036-090438 Issued in IL

Practice address

800 E 55TH St
Chicago, IL 60615

Phone

(773) 702-0660

NPI assigned

Apr 19, 2006

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

Medicare fee-for-service enrollment

Enrolled in IL

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 and National Provider Directory roles.

• Friend Family Health Center Inc

  • Federally Qualified Health Center (FQHC)
  • Chicago, IL
  • NPI 1578560090
  Medicare reassignment NPD
• Friend Family Health Center Inc

  • Federally Qualified Health Center (FQHC)
  • Chicago, IL
  • NPI 1477175305
  NPD
• Friend Family Health Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Chicago, IL
  • NPI 1861667404
  NPD (past)

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

{
    "created_epoch": "1145404800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1528070400000",
    "number": "1629033048",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 E 55TH ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606154906",
            "telephone_number": "773-795-2260",
            "fax_number": "773-834-3756"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 E 55TH ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60615",
            "telephone_number": "773-702-0660"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "121 W 154th St",
            "address_purpose": "LOCATION",
            "city": "Harvey",
            "state": "IL",
            "postal_code": "604263552",
            "country_code": "US",
            "telephone_number": "708-596-2220",
            "fax_number": "708-596-2258",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NICKSON",
        "first_name": "PAMELA",
        "middle_name": "ELAINE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-19",
        "last_updated": "2018-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "036-090438",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brian E Nickerson, LCSW
• Lauren Elizabeth Nickerson, MS, RD, LDN
• Melissa Ashley Nickles
• John Nickless Jr., M.D.
• Debra Renae Nickoli, PT
• Lara Kathryn Nicol, M.D.
• Terry L Nicola, M.D., M.S.
• Sarah Marie Nicolarsen, P.T., D.P.T
• Sarah Nicolas Cruz
• John D Nicolas, MD

• Pediatrics Physician in Chicago, IL
• Providers in Chicago, IL by specialty
• Pediatrics Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2018; 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.