Kristine Geronimo Nicolas, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

A122983 Issued in CA

Practice address

5256 Mission Blvd
Riverside, CA 92509-4624

Phone

(951) 955-5310

NPI assigned

Aug 5, 2010

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: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: knicolas96847@direct.llu.edu

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.

• County of Riverside

  • Federally Qualified Health Center (FQHC)
  • Indio, CA
  • NPI 1023122967
  Medicare reassignment NPD
• County of Riverside

  • Community/Behavioral Health Agency
  • Riverside, CA
  • NPI 1639574726
  NPD
• County of Riverside

  • Clinical Medical Laboratory
  • Riverside, CA
  • NPI 1952496010
  NPD

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

{
    "created_epoch": "1280966400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1495584000000",
    "number": "1851605554",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5256 MISSION BLVD",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "92709",
            "telephone_number": "951-955-0840"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5256 MISSION BLVD",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925094624",
            "telephone_number": "951-955-5310"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICOLAS",
        "first_name": "KRISTINE",
        "middle_name": "GERONIMO",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-08-05",
        "last_updated": "2017-05-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A122983",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OH",
            "license": "57-017398",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rachel Nicholson
• Dwayne Nickerson
• Nickes Medical Supply, LLC.
• Kenneth Nickson, M.D
• Christofer Michael Nicodemus
• Micaela Nicolas
• Jaye Nicole
• Laura Marie Nicoletti, BA
• Roger Guy Nicosia, MD
• Carmelita Nidoy, MS, RD, CDCES

• Internal Medicine Physician in Riverside, CA
• Providers in Riverside, CA by specialty
• Internal Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2017; 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.