Active NPI
Nicholas Krishnan
- Physician Assistant
- Decatur, AL
National Provider Identifier
1699169474
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA-1045
- Practice address
- 1103 16TH Ave SE
Decatur, AL 35601-3595 - Phone
- (256) 350-0362
- Fax
- (256) 355-9779
- NPI assigned
- Mar 19, 2015
- Last updated
- May 16, 2015
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA-1045 | AL | Primary |
Addresses
Primary practice location
1103 16TH Ave SE
Decatur, AL 35601-3595
Mailing address
1103 16TH Ave SE
Decatur, AL 35601-3595
Phone (256) 350-0362
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PA.1045 | Other | AL | ALABAMA PA LICENSE |
| 170557 | Medicaid | AL | |
| 51160179 | Other | AL | BLUE CROSS BLUE SHIELD OF ALABAMA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA-1045 | AL | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Gafford Family Medicine | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Family Medicine Physician
- Fayetteville, TN
- NPI 1740418128
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1426723200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1431734400000",
"number": "1699169474",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1103 16TH AVE SE",
"city": "DECATUR",
"state": "AL",
"postal_code": "356013595",
"telephone_number": "256-350-0362",
"fax_number": "256-355-9779"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1103 16TH AVE SE",
"city": "DECATUR",
"state": "AL",
"postal_code": "356013595",
"telephone_number": "256-350-0362",
"fax_number": "256-355-9779"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KRISHNAN",
"first_name": "NICHOLAS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-03-19",
"last_updated": "2015-05-16",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "AL",
"license": "PA-1045",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ALABAMA PA LICENSE",
"identifier": "PA.1045",
"state": "AL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "170557",
"state": "AL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD OF ALABAMA",
"identifier": "51160179",
"state": "AL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Decatur, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.