NPIMap

Individual provider Active NPI

Larry Thomas Nickell Jr., MD

  • Diagnostic Radiology Physician
  • Albany, NY
National Provider Identifier
1669797346
Registry record updated May 19, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
308425 Issued in NY
Practice address
315 South Manning Blvd
Albany, NY 12208-6819
Phone
(518) 525-1401
NPI assigned
Apr 6, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 19, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X DR.0056434 CO
Diagnostic Radiology Physician 2085R0202X 308425 CO
Diagnostic Radiology Physician 2085R0202X 308425 NY Primary

Addresses

Primary practice location

315 South Manning Blvd
Albany, NY 12208-6819

Mailing address

PO Box 14890
Albany, NY 12212-4890
Phone (518) 525-5634

Other practice location 1

2222 N Nevada Ave
Colorado Springs, CO 80907-6819
Phone (719) 593-1799

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address payer.credentialing@sphp.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160816002509 CO Practitioner - Diagnostic Radiology 0840592093 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
University of Texas Medical School at Houston, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Boulder Radiologists Inc P CGroup PAC ID 4183510274, 13 clinicians

Practice addresses (Care Compare)

4747 Arapahoe Ave
Boulder, CO 80303-1131
Phone (303) 465-0401

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
308425COMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Boulder Radiologists Inc P C Diagnostic Radiology CurrentSince Oct 6, 2023 Accepting new patients
Mountain Radiology, Inc Diagnostic Radiology CurrentSince Nov 1, 2022 Accepting new patients
Bouldercentre for Orthopedics PC PastSince Oct 6, 2023 Accepting new patients

Locations

4740 Pearl Pkwy
Ste 110
Boulder, CO 80301

4747 Arapahoe Ave
Boulder, CO 80303
Phone (303) 415-7000

6685 Gunpark Dr
Ste 102
Boulder, CO 80301
Phone (303) 415-5199

2750 Broadway St
Boulder, CO 80304
Phone (303) 440-3000

101 Erie Pkwy
Erie, CO 80516
Phone (303) 415-5170

1906 Blake Ave
Glenwood Springs, CO 81601
Phone (970) 384-7033

2635 N 7th St
Grand Junction, CO 81501
Phone (970) 244-2009

1000 W South Boulder Rd
Ste 105
Lafayette, CO 80026
Phone (303) 604-5031

Interoperability endpoints

  • Direct secure messaging: lnickell968301@direct.trinity-health.org

Organizations & group practices 3

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 62

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 62

NPI Registry JSON

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

{
    "created_epoch": "1270512000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621382400000",
    "number": "1669797346",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 14890",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122124890",
            "telephone_number": "518-525-5634"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "315 SOUTH MANNING BLVD",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122086819",
            "telephone_number": "518-525-1401"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2222 N Nevada Ave",
            "address_purpose": "LOCATION",
            "city": "Colorado Springs",
            "state": "CO",
            "postal_code": "809076819",
            "country_code": "US",
            "telephone_number": "719-593-1799",
            "fax_number": "719-265-3794",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NICKELL",
        "first_name": "LARRY",
        "middle_name": "THOMAS",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-04-06",
        "last_updated": "2021-05-19",
        "certification_date": "2021-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "CO",
            "license": "DR.0056434",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "CO",
            "license": "308425",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NY",
            "license": "308425",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "payer.credentialing@sphp.com",
            "affiliation": "N",
            "endpointDescription": "SPHP Payer Credentialing",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "315 SOUTH MANNING BLVD",
            "city": "ALBANY",
            "state": "NY",
            "country_code": "US",
            "postal_code": "122086819",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Albany, NY

Sources for this page

Verify at the official NPI Registry.