Individual provider Active NPI

Robert L Nichols, MD

  • General Practice Physician
  • Santa Teresa, NM
National Provider Identifier
1679634562
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
94-344 Issued in NM
Practice address
1300 Country Club Road
Santa Teresa, NM 88008
Phone
(505) 589-4000
Fax
(505) 589-7225
NPI assigned
Dec 13, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 94-344 NM
General Practice Physician 208D00000X 94-344 NM Primary

Addresses

Primary practice location

1300 Country Club Road
Santa Teresa, NM 88008

Mailing address

PO Box 1558
Santa Teresa, NM 88008
Phone (505) 589-4000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NM
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
I20041117001251 NM Practitioner - Family PracticePractitioner - General Practice 6901860071 Practice locations: Santa Teresa, NM

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: General Practice
Education
University of New Mexico School of Medicine, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1300 Country Club Rd
Suite D
Santa Teresa, NM 88008-9449

1300 Country Club Rd D
Santa Teresa, NM 88008-9449
Phone (505) 589-4000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
94-344NMMDGeneral Practice Physician

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": "1165968000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757548800000",
    "number": "1679634562",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1558",
            "city": "SANTA TERESA",
            "state": "NM",
            "postal_code": "88008",
            "telephone_number": "505-589-4000",
            "fax_number": "505-589-7225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 COUNTRY CLUB ROAD",
            "city": "SANTA TERESA",
            "state": "NM",
            "postal_code": "88008",
            "telephone_number": "505-589-4000",
            "fax_number": "505-589-7225"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICHOLS",
        "first_name": "ROBERT",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-13",
        "last_updated": "2025-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NM",
            "license": "94-344",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NM",
            "license": "94-344",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Teresa, NM

Sources for this page

Verify at the official NPI Registry.