Alexis C Nicodemus

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

LMFT134809 Issued in CA

Practice address

10419 Old Placerville Rd
Sacramento, CA 95827-2509

Phone

(916) 366-0647

NPI assigned

Sep 22, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Permanente Medical Group Inc

  • Internal Medicine Physician
  • Santa Clara, CA
  • NPI 1073606299
  Medicare reassignment NPD
• Permanente Medical Group Inc

  • Internal Medicine Physician
  • Stockton, CA
  • NPI 1548343510
  NPD
• Permanente Medical Group, Inc

  • Clinical Medical Laboratory
  • San Jose, CA
  • NPI 1497971584
  NPD

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

{
    "created_epoch": "1600732800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674604800000",
    "number": "1841806049",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10419 OLD PLACERVILLE RD",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958272509"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10419 OLD PLACERVILLE RD",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958272509",
            "telephone_number": "916-366-0647"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICODEMUS",
        "first_name": "ALEXIS",
        "middle_name": "C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-09-22",
        "last_updated": "2023-01-25",
        "certification_date": "2023-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "LMFT134809",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Edward C Nickerson, RPT
• Gasong Yun Nickerson
• William A. Nickerson, MD
• Sydney Dawn Nickolas
• Nicobre Health Services
• Carol A Nicol, R.N.
• Cassandra Marie Nicolaysen
• Cynthia Louise Nicolaysen
• Kayelene Nicolazzi
• Nicole Pardo, MD, Inc

• Marriage & Family Therapist in Sacramento, CA
• Providers in Sacramento, CA by specialty
• Marriage & Family Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2023; 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.