Individual provider Active NPI

Jillian Nickerson

  • Emergency Medicine Physician
  • Washington, DC
National Provider Identifier
1851785794
Registry record updated Aug 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
MD047065 Issued in DC
Practice address
111 Michigan Ave NW
Washington, DC 20010
Phone
(202) 476-5000
NPI assigned
Mar 27, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 11, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X MD047065 DC Primary

Addresses

Primary practice location

111 Michigan Ave NW
Washington, DC 20010

Mailing address

PO Box 744785
Atlanta, GA 30374-4785
Phone (202) 476-5000

Other practice location 1

1 Gustave L Levy Pl
New York, NY 10029-6504
Phone (212) 241-6500

Other practice location 2

2120 L St NW Ste 450
Washington, DC 20037-1541
Phone (202) 741-2904

Other practice location 3

111 Michigan Ave NW
Washington, DC 20010
Phone (202) 476-5000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC, MD2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20190816002989 DC Practitioner - Emergency MedicinePractitioner - Pediatric Medicine 7214273457 Reassigns benefits to 2 organizations
I20210510001697 MD Practitioner - Emergency Medicine 7214273457 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Children'S HospitalGroup PAC ID 0244143170, 212 clinicians

Practice addresses (Care Compare)

111 Michigan Ave NW
Washington, DC 20010-2916
Phone (301) 572-3514

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Children'S Hospital Current Accepting new patients
Children'S Hospital CurrentSince Jul 2, 2019 Accepting new patients
WHC Physician Group LLC CurrentSince Jun 1, 2021 Accepting new patients
WHC Emerg Phys CurrentSince Jun 1, 2021 Accepting new patients
Children'S Hospital CurrentSince Jul 2, 2019 Accepting new patients

Locations

111 Michigan Ave NW
Washington, DC 20010
Phone (202) 476-3670

2021 K St NW
Ste 408
Washington, DC 20006
Phone (202) 223-1024

110 Irving St NW
Washington, DC 20010
Phone (202) 877-2000

900 23rd St NW
Washington, DC 20037
Phone (202) 715-4750

3001 S Hanover St
Brooklyn Park, MD 21225
Phone (410) 350-3200

25500 Point Lookout Rd
Leonardtown, MD 20650
Phone (301) 475-6106

11355 Pembrooke Sq
Ste 108
Waldorf, MD 20603
Phone (202) 877-6733

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1427414400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1565481600000",
    "number": "1851785794",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 744785",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303744785",
            "telephone_number": "202-476-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 MICHIGAN AVE NW",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "20010",
            "telephone_number": "202-476-5000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Gustave L Levy Pl",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "100296504",
            "country_code": "US",
            "telephone_number": "212-241-6500",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2120 L St NW Ste 450",
            "address_purpose": "LOCATION",
            "city": "Washington",
            "state": "DC",
            "postal_code": "200371541",
            "country_code": "US",
            "telephone_number": "202-741-2904",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "111 Michigan Ave NW",
            "address_purpose": "LOCATION",
            "city": "Washington",
            "state": "DC",
            "postal_code": "20010",
            "country_code": "US",
            "telephone_number": "202-476-5000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NICKERSON",
        "first_name": "JILLIAN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-03-27",
        "last_updated": "2019-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "DC",
            "license": "MD047065",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Washington, DC

Sources for this page

Verify at the official NPI Registry.