Amoret E. Nicklisch, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA19105 Issued in CA

Practice address

2020 Sutter PL Ste 101
Davis, CA 95616

Phone

(530) 750-5900

Fax

(530) 750-5891

NPI assigned

Jun 28, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

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: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Sutter Valley Medical FoundationGroup PAC ID 9830094515, 2,473 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: anicklisch265149@hisp.ehr.sutterhealth.org

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.

• Sutter Valley Medical Foundation

  • Multi-Specialty Clinic/Center
  • Modesto, CA
  • NPI 1669846986
  Medicare reassignment Care Compare group NPD
• Sutter Valley Medical Foundation

  • Durable Medical Equipment & Medical Supplies
  • Tracy, CA
  • NPI 1720930712
  NPD
• Sansum Clinic

  • Ambulatory Surgical Clinic/Center
  • Santa Barbara, CA
  • NPI 1649296807
  NPD (past)

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

{
    "created_epoch": "1182988800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1551225600000",
    "number": "1699972158",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10470 OLD PLACERVILLE RD STE 100",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958272539",
            "telephone_number": "800-470-0071"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2020 SUTTER PL STE 101",
            "city": "DAVIS",
            "state": "CA",
            "postal_code": "95616",
            "telephone_number": "530-750-5900",
            "fax_number": "530-750-5891"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12395 El Camino Real",
            "address_purpose": "LOCATION",
            "city": "San Diego",
            "state": "CA",
            "postal_code": "921303082",
            "country_code": "US",
            "telephone_number": "858-793-2727",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NICKLISCH",
        "first_name": "AMORET",
        "middle_name": "E.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-28",
        "last_updated": "2019-02-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "19105",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CA",
            "license": "PA19105",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL BOARD OF PA",
            "identifier": "19105",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Patrick Hoang Nguyen
• Ryan Phan Nguyen
• Amy Nham, DO
• Phoebe Ann Nicholas
• Jacqueline Nichols, NP
• Macara Marie Nicoll
• Kellie Nielsen, DPT
• Nightingale Medical Centers, Inc.
• Francesca Nikolic
• Laila Niyati

• Medical Physician Assistant in Davis, CA
• Providers in Davis, CA by specialty
• Medical Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2019; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.