Clifton Mark Nichols, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

13491 Issued in TX

Practice address

1427 Hawthorne St
Houston, TX 77006-3711

Phone

(713) 524-7933

Fax

(713) 834-3540

NPI assigned

May 6, 2008

Last updated

May 6, 2008By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: cnichols368005@direct.ochin.org
• Direct secure messaging: dental@avenue360.directbygreenway.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Houston Area Community Services, Inc.

  dba Avenue 360 Health and Wellness

  • Federally Qualified Health Center (FQHC)
  • Houston, TX
  • NPI 1477795417
  Medicare reassignment
• Houston Area Community Services Inc.

  dba Avenue 360 Health and Wellness

  • Federally Qualified Health Center (FQHC)
  • Houston, TX
  • NPI 1285061978
  NPD
• Houston Area Community Services, Inc.

  dba Avenue 360 Health and Wellness

  • Federally Qualified Health Center (FQHC)
  • Houston, TX
  • NPI 1053539262
  NPD
• Houston Area Community Services Inc.

  dba Avenue 360 Health and Wellness Fannin

  • Federally Qualified Health Center (FQHC)
  • Houston, TX
  • NPI 1639752124
  NPD (past)

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

{
    "created_epoch": "1210032000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1210032000000",
    "number": "1811163249",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1427 HAWTHORNE ST",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770063711",
            "telephone_number": "713-524-7933",
            "fax_number": "713-834-3540"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1427 HAWTHORNE ST",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770063711",
            "telephone_number": "713-524-7933",
            "fax_number": "713-834-3540"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICHOLS",
        "first_name": "CLIFTON",
        "middle_name": "MARK",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-05-06",
        "last_updated": "2008-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "13491",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0077166-01",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sarah McNeal Nicholls, OTR, MOT
• Amber Brittany Nichols, OD
• Andrew James Nichols, PMHNP
• Candace M Nichols, FNP-C
• Christian Nichols
• Diana Adams Nichols, NP
• E Dan Nichols
• Gina Allison Nichols, M.D.
• Jason Pinkard Nichols, M.D.
• Johnnetta Matrice Nichols

• General Practice Dentistry in Houston, TX
• Providers in Houston, TX by specialty
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2008; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.