Organization Active NPI

Dianne W. Nicholas M.D., PA

  • Internal Medicine Physician
  • Houston, TX
National Provider Identifier
1821263468
Registry record updated Aug 28, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
J2238 Issued in TX
Legal business name
DIANNE W. NICHOLAS M.D., PA
Practice address
5160 Timber Creek Dr
Houston, TX 77017-5968
Phone
(713) 440-0602
Fax
(713) 944-8903
NPI assigned
Apr 24, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2009

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

Authorized official

Name
Dr. Dianne Nicholas, MDNPI 1679553499
Title
President
Phone
(713) 440-0602

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X J2238 TX Primary

Addresses

Primary practice location

5160 Timber Creek Dr
Houston, TX 77017-5968

Mailing address

PO Box 14231
Houston, TX 77221-4231
Phone (713) 440-0602

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100816000549 TX Part B Supplier - Clinic/Group Practice 4587798368 Receives reassigned benefits from 1 practitioner
Practice locations: Houston, TX

National Provider Directory

National Provider Directory

Locations

5160 Timber Creek Dr
Houston, TX 77017
Phone (713) 440-0602

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1208995200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1251417600000",
    "number": "1821263468",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 14231",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "772214231",
            "telephone_number": "713-440-0602",
            "fax_number": "713-944-8903"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5160 TIMBER CREEK DR",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770175968",
            "telephone_number": "713-440-0602",
            "fax_number": "713-944-8903"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIANNE W. NICHOLAS M.D., PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-24",
        "last_updated": "2009-08-28",
        "status": "A",
        "authorized_official_last_name": "NICHOLAS",
        "authorized_official_first_name": "DIANNE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "713-440-0602",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "J2238",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Houston, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.