Michael David Nickerson Jr., M.D.

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

License

2019-02595 Issued in NC

Practice address

2817 Rock Merritt Ave Stop a
Fort Liberty, NC 28310-7394

Phone

(910) 908-2318

NPI assigned

Mar 24, 2009

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

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 1

Specialty

Anesthesiology

Education

Other, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Medstream Anesthesia PLLCGroup PAC ID 7416198049, 571 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Southeastern Regional Medical Center Hospital, Lumberton, NC, CCN 340050

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mnickerson859684@direct.unc.nchie.net

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.

• Medstream Anesthesia PLLC

  • Anesthesiology Physician
  • Richardson, TX
  • NPI 1649616160

  NC

  Medicare reassignment Care Compare group NPD
• American Anesthesiology of North Carolina, PLLC

  • Anesthesiology Physician
  • Wilmington, NC
  • NPI 1033412267
  Medicare reassignment NPD
• Southeast Anesthesiology Consultants, PLLC

  • Anesthesiology Physician
  • Charlotte, NC
  • NPI 1538124201
  Medicare reassignment NPD
• American Anesthesiology of North Carolina, PLLC

  • Certified Registered Nurse Anesthetist
  • Burlington, NC
  • NPI 1053677195

  Anesthesiology

  NPD
• Southeast Anesthesiology Consultants, PLLC

  • Anesthesiology Physician
  • Wilmington, NC
  • NPI 1932402195
  NPD

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

• Southeastern Regional Medical Center

  • General Acute Care Hospital
  • Lumberton, NC
  • NPI 1427030774
  Care Compare affiliation

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

{
    "created_epoch": "1237852800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1735689600000",
    "number": "1790927671",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2817 ROCK MERRITT AVE STOP A",
            "city": "FORT LIBERTY",
            "state": "NC",
            "postal_code": "283100001",
            "telephone_number": "910-907-8707"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2817 ROCK MERRITT AVE STOP A",
            "city": "FORT LIBERTY",
            "state": "NC",
            "postal_code": "283107394",
            "telephone_number": "910-908-2318"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICKERSON",
        "first_name": "MICHAEL",
        "middle_name": "DAVID",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-03-24",
        "last_updated": "2025-01-01",
        "certification_date": "2025-01-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "TX",
            "license": "Q4227",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "VA",
            "license": "0101246915",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "NC",
            "license": "2019-02595",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Daniel J Neller, PSYD
• Casey Nelson, PH.D.
• Ruth Anne Nelson, DDS
• Sharon A Neubauer, LISW-CP
• Melanie Newman, D.D.S.
• Jason Paul Norlien, PSY.D.
• Thomas C Notto, PA-C
• Michael Oien, PSY.D.
• John C Okiishi, PHD
• Laurie Ann Oliver, REGISTERED NURSE

• Anesthesiology Physician in Fort Liberty, NC
• Providers in Fort Liberty, NC by specialty
• Anesthesiology Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 1, 2025; 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.