Individual provider Active NPI

Nicholena Richardson, MD

  • Emergency Medicine Physician
  • Charlotte, NC
National Provider Identifier
1760913073
Registry record updated Apr 6, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
2020-02239 Issued in NC
Practice address
1000 Blythe Blvd
Charlotte, NC 28203-5812
Phone
(704) 355-2171
NPI assigned
Mar 27, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 6, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 2020-02239 NC Primary

Addresses

Primary practice location

1000 Blythe Blvd
Charlotte, NC 28203-5812

Mailing address

PO Box 19305
Charlotte, NC 28219-9305

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address nrichardson537250@CarolinasHealthcareSystem.direct-ci.com Atrium Health
CONNECT URL https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other ABILITY Network

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC, FL2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20200625001327 NC Practitioner - Emergency Medicine 1557648219 Reassigns benefits to 1 organization
I20220606000606 FL Practitioner - Emergency Medicine 1557648219 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Observation Medical Group LLCGroup PAC ID 3779872627, 51 clinicians
Emergency Medical Associates of Tampa Bay LLCGroup PAC ID 3678746674, 84 clinicians

Practice addresses (Care Compare)

3001 W Dr Martin Luther King Jr Blvd
Tampa, FL 33607-6307
Phone (813) 870-4000

4501 Bruce B Downs Blvd
Wesley Chapel, FL 33544-9216
Phone (813) 870-4000

6901 Simmons Loop
Riverview, FL 33578-9498
Phone (813) 302-8000

Hospital & facility affiliations

  • St Josephs Hospital Hospital, Tampa, FL, CCN 100075

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2020-02239NCMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Observation Medical Group LLC Emergency Medicine CurrentSince Jun 15, 2022 Accepting new patients
Emergency Medical Associates of Tampa Bay, LLC Emergency Medicine CurrentSince Jun 15, 2022 Accepting new patients
Carolinas Medical Center CurrentSince Jul 1, 2020 Accepting new patients
Carolinas Medical Center CurrentSince Jul 1, 2020 Accepting new patients
Carolinas Medical Center Current Accepting new patients
Observation Medical Group LLC Emergency Medicine CurrentSince Jun 15, 2022 Accepting new patients

Locations

4211 Van Dyke Rd
Lutz, FL 33558
Phone (813) 265-6300

6901 Simmons Loop
Riverview, FL 33578
Phone (813) 302-8000

3001 W Mlk Blvd
Tampa, FL 33607
Phone (813) 361-6778

4501 Bruce B Downs Blvd
Wesley Chapel, FL 33544
Phone (813) 870-4000

100 N 6th St
Ste 900A
Minneapolis, MN 55403

1000 Blythe Blvd
Charlotte, NC 28203
Phone (704) 351-3791

Interoperability endpoints

  • Direct secure messaging: nrichardson537250@carolinashealthcaresystem.direct-ci.com

Organizations & group practices 6

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 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": "1490572800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649203200000",
    "number": "1760913073",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19305",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282199305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 BLYTHE BLVD",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282035812",
            "telephone_number": "704-355-2171"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RICHARDSON",
        "first_name": "NICHOLENA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-03-27",
        "last_updated": "2022-04-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NC",
            "license": "2020-02239",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "nrichardson537250@CarolinasHealthcareSystem.direct-ci.com",
            "affiliation": "Y",
            "affiliationName": "Atrium Health",
            "address_1": "1000 Blythe Blvd",
            "city": "Charlotte",
            "state": "NC",
            "country_code": "US",
            "postal_code": "282035812",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.667.2",
            "affiliationName": "ABILITY Network",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "100 N 6th St Ste 900A",
            "city": "Minneapolis",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554031516",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

Verify at the official NPI Registry.