NPIMap

Individual provider Active NPI

Kacy Leigh Nichols, DO

  • Family Medicine Physician
  • Gastonia, NC
National Provider Identifier
1770103780
Registry record updated Aug 24, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
2022-02982 Issued in NC
Practice address
885 Summit Crossing Place
Gastonia, NC 28054-2193
Phone
(704) 316-4979
Fax
(704) 316-4978
NPI assigned
Apr 20, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 24, 2023

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 2022-02982 NC Primary
Family Medicine Physician 207Q00000X 260755 NC

Addresses

Primary practice location

885 Summit Crossing Place
Gastonia, NC 28054-2193

Mailing address

PO Box 60447
Charlotte, NC 28260-0447

Other practice location 1

8560 Cook St
MT Pleasant, NC 28124-7686
Phone (704) 436-6521

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
I20231017003968 NC Practitioner - Family Practice 4688096233 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2020
Medicare assignment
May accept Medicare assignment
Telehealth
Offers telehealth services
Group practices
Novant Health Medical Group, LLC 2,413 clinicians
Comprehab, Inc 376 clinicians
Legacy Healthcare Services Inc 3,431 clinicians

Practice addresses (Care Compare)

10810 Mallard Creek Rd
Charlotte, NC 28262-9786
Phone (704) 510-8000

2675 Court Dr
Gastonia, NC 28054-1478
Phone (704) 824-7800

2701 Pickett Rd
Durham, NC 27705-5688
Phone (919) 419-9600

Hospital & facility affiliations

  • Adoration Home Health Home health agency, Gastonia, NC, CCN 347131
  • Bayada Home Health Care Inc Home health agency, Gastonia, NC, CCN 347326
  • Caromont Regional Medical Center Hospital, Gastonia, NC, CCN 340032
  • Novant Health Presbyterian Medical Center Hospital, Charlotte, NC, CCN 340053

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Novant Health Medical Group, LLC Current Accepting new patients
Novant Health Medical Group, LLC CurrentSince Aug 1, 2023 Accepting new patients
Novant Health Medical Group, LLC CurrentSince Aug 1, 2023 Accepting new patients

Locations

10810 Mallard Creek Rd
Charlotte, NC 28262
Phone (704) 510-8000

885 Summit Crossing Pl
Gastonia, NC 28054
Phone (704) 316-4979

2290 Remount Rd
Gastonia, NC 28054
Phone (704) 316-4979

5145 Sellers Rd
Shallotte, NC 28470
Phone (910) 754-4441

2825 Lyndhurst Ave
Ste 101
Winston Salem, NC 27103
Phone (336) 277-6300

Interoperability endpoints

  • Direct secure messaging: knichols1151125@direct.novanthealth.org

Organizations & group practices 17

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 17

Hospital & facility affiliations 7

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": "1587340800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692835200000",
    "number": "1770103780",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 60447",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282600447"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "885 SUMMIT CROSSING PLACE",
            "city": "GASTONIA",
            "state": "NC",
            "postal_code": "280542193",
            "telephone_number": "704-316-4979",
            "fax_number": "704-316-4978"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8560 Cook St",
            "address_purpose": "LOCATION",
            "city": "MT Pleasant",
            "state": "NC",
            "postal_code": "281247686",
            "country_code": "US",
            "telephone_number": "704-436-6521",
            "fax_number": "704-436-9505",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NICHOLS",
        "first_name": "KACY",
        "middle_name": "LEIGH",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-04-20",
        "last_updated": "2023-08-24",
        "certification_date": "2023-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "2022-02982",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "260755",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gastonia, NC

Sources for this page

Verify at the official NPI Registry.