Individual provider Active NPI

Tim Nicholls, M.D.

  • Pediatrics Physician
  • San Francisco, CA
National Provider Identifier
1629090022
Registry record updated Jul 13, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
A73793 Issued in CA
Practice address
3700 California St
Department of Pediatrics
San Francisco, CA 94118-1618
Phone
(415) 923-3291
NPI assigned
Jul 24, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X A73793 CA Primary

Addresses

Primary practice location

3700 California St
Department of Pediatrics
San Francisco, CA 94118-1618

Mailing address

PO Box 254947
Sacramento, CA 95865-4947
Phone (916) 854-6975

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20040226001229 CA Practitioner - Pediatric Medicine 9638065493 Reassigns benefits to 3 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A73793CAMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University of California San Francisco Pediatrics CurrentSince Jul 27, 2021 Accepting new patients
UCSF Pediatrics Associates Pediatrics CurrentSince Jul 27, 2021 Accepting new patients
University of California San Francisco Pediatrics Current Accepting new patients
UCSF Medical Group Business Services CurrentSince Jul 27, 2021 Accepting new patients
UCSF Medical Group Business Services CurrentSince Jul 27, 2021 Accepting new patients
University of California San Francisco CurrentSince Jul 27, 2021 Accepting new patients
University of California San Francisco Medical Center Past Accepting new patients

Locations

747 52nd St
Oakland, CA 94609
Phone (510) 428-3070

2330 Post St
San Francisco, CA 94115
Phone (415) 502-4444

505 Parnassus Ave
San Francisco, CA 94143
Phone (415) 476-9058

3700 California St
San Francisco, CA 94118
Phone (415) 719-0000

3838 California St
Rm 404
San Francisco, CA 94118
Phone (415) 600-0940

400 Parnassus Ave
#A632
San Francisco, CA 94143
Phone (415) 473-1000

300 Pasteur Dr
Stanford, CA 94305
Phone (650) 498-5710

Interoperability endpoints

  • Direct secure messaging: tnicholls141754@hisp.ehr.sutterhealth.org

Organizations & group practices 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1153699200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1184284800000",
    "number": "1629090022",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 254947",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958654947",
            "telephone_number": "916-854-6975",
            "fax_number": "916-854-6864"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3700 CALIFORNIA ST",
            "address_2": "DEPARTMENT OF PEDIATRICS",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941181618",
            "telephone_number": "415-923-3291"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICHOLLS",
        "first_name": "TIM",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-24",
        "last_updated": "2007-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A73793",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Francisco, CA

Sources for this page

Verify at the official NPI Registry.