NPIMap

Individual provider Active NPI

Dejan Nikolic, PA-C

  • Physician Assistant
  • Lenoir, NC
National Provider Identifier
1760182372
Registry record updated Mar 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0010-13100 Issued in NC
Practice address
401 Mulberry St SW Ste 102
Lenoir, NC 28645-5463
Phone
(182) 875-7643
NPI assigned
Mar 3, 2023
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 6, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X
Surgical Physician Assistant 363AS0400X 0010-13100 NC
Physician Assistant 363A00000X 0010-13100 NC Primary

Addresses

Primary practice location

401 Mulberry St SW Ste 102
Lenoir, NC 28645-5463

Mailing address

401 Mulberry St SW Ste 102
Lenoir, NC 28645-5463
Phone (182) 875-7643

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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
I20230503000464 NC Practitioner - Physician Assistant 9537524244 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Caldwell Memorial Hospital Inc 212 clinicians

Practice addresses (Care Compare)

160 River Bend Dr
Granite Falls, NC 28630-9371

321 Mulberry St SW
Lenoir, NC 28645-5720
Phone (828) 757-5218

401 Mulberry St SW
Lenoir, NC 28645-5463

Hospital & facility affiliations

  • Caldwell Memorial Hospital Hospital, Lenoir, NC, CCN 340041
  • Watauga Medical Center Hospital, Boone, NC, CCN 340051

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Caldwell Memorial Hospital Inc. CurrentSince Apr 13, 2023 Accepting new patients
Blowing Rock Medical Clinic PR Current Accepting new patients
Caldwell Memorial Hospital, Inc. CurrentSince Apr 13, 2023 Accepting new patients
Caldwell Memorial Hospital, Inc Past Accepting new patients

Locations

8439 Valley Blvd
Blowing Rock, NC 28605
Phone (828) 295-3116

160 River Bend Dr
Ste A
Granite Falls, NC 28630
Phone (828) 757-5042

401 Mulberry St SW
Ste 102
Lenoir, NC 28645
Phone (828) 757-6434

5221 Paramount Pkwy
Ste 420
Morrisville, NC 27560
Phone (984) 215-6533

Organizations & group practices 16

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.

View all 16

Hospital & facility affiliations 2

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": "1677801600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678060800000",
    "number": "1760182372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 MULBERRY ST SW STE 102",
            "city": "LENOIR",
            "state": "NC",
            "postal_code": "286455463",
            "telephone_number": "182-875-7643"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 MULBERRY ST SW STE 102",
            "city": "LENOIR",
            "state": "NC",
            "postal_code": "286455463",
            "telephone_number": "182-875-7643"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NIKOLIC",
        "first_name": "DEJAN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-03-03",
        "last_updated": "2023-03-06",
        "certification_date": "2023-03-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "NC",
            "license": "0010-13100",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-13100",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lenoir, NC

Sources for this page

Verify at the official NPI Registry.