NPIMap

Individual provider Active NPI

Diana Marie Mikulencak-Picha, NP-C

  • Nurse Practitioner
  • Gonzales, TX
National Provider Identifier
1790283596
Registry record updated Jan 26, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
AP136271 Issued in TX
Practice address
1110 N Sarah Dewitt Dr
Gonzales, TX 78629-3311
Phone
(830) 672-8502
NPI assigned
Jan 26, 2018
Sex
Female
Sole proprietor
No

Organizations & group practices 10

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 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Gonzales Healthcare Systems 35 clinicians

Practice addresses (Care Compare)

1110 N Sarah Dewitt Dr
Gonzales, TX 78629-3311
Phone (830) 672-7581

Hospital & facility affiliations

  • Memorial Hospital Home Health Agency Home health agency, Gonzales, TX, CCN 457634
  • Memorial Hospital Hospital, Gonzales, TX, CCN 450235
  • Guadalupe Regional Medical Center Hospital, Seguin, TX, CCN 450104
  • Yoakum Community Hospital Hospital, Yoakum, TX, CCN 451346

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Medicare enrollment records 1

Medicare enrollment files
Enrollment IDStateProvider typePAC IDDetails
I20180329000622 TX Practitioner - Nurse Practitioner 8527320654 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
830443TXMDRegistered Nurse
AP136271TXMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Gonzales Healthcare Systems CurrentSince Jan 24, 2018 Accepting new patients
Gonzales Healthcare Systems CurrentSince Jan 24, 2018 Accepting new patients
Gonzales Healthcare Systems Current Accepting new patients

Locations

1110 N Sarah Dewitt Dr
Gonzales, TX 78629
Phone (830) 672-3845

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

Specialties & licenses 2

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 830443 TX
Nurse Practitioner 363L00000X AP136271 TX Primary

Addresses

NPPES NPI Registry

Primary practice location

1110 N Sarah Dewitt Dr
Gonzales, TX 78629-3311

Mailing address

1430 N Avenue B
Shiner, TX 77984-6220
Phone (361) 401-1344

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jan 26, 2018.

{
    "created_epoch": "1516924800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1516924800000",
    "number": "1790283596",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1430 N AVENUE B",
            "city": "SHINER",
            "state": "TX",
            "postal_code": "779846220",
            "telephone_number": "361-401-1344"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1110 N SARAH DEWITT DR",
            "city": "GONZALES",
            "state": "TX",
            "postal_code": "786293311",
            "telephone_number": "830-672-8502"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIKULENCAK-PICHA",
        "first_name": "DIANA",
        "middle_name": "MARIE",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-01-26",
        "last_updated": "2018-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "TX",
            "license": "830443",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "TX",
            "license": "AP136271",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gonzales, TX

Sources for this page

Verify at the official NPI Registry.