NPIMap

Individual provider Active NPI

Nathan Lee Nicolet, P.A.-C

  • Surgical Physician Assistant
  • Reno, NV
National Provider Identifier
1861678153
Registry record updated Apr 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
PA10084 Issued in NV
Practice address
555 N Arlington Ave
Reno, NV 89503-4723
Phone
(775) 786-3040
Fax
(775) 788-5216
NPI assigned
Jan 16, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X PA10084 NV Primary

Addresses

Primary practice location

555 N Arlington Ave
Reno, NV 89503-4723

Mailing address

555 N Arlington Ave
Reno, NV 89503-4723
Phone (775) 786-3040

Other identifiers 2

IdentifierTypeStateIssuer
12227280OtherCAQH
1861678153MedicaidNV

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address nnicolet85491@Direct.renown.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130415000259 NV Practitioner - Physician Assistant 3870651730 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Western University of Health Sciences College of Dental Med, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Reno Orthopaedic Clinic LTDGroup PAC ID 2567355316, 96 clinicians

Practice addresses (Care Compare)

555 N Arlington Ave
Reno, NV 89503-4723
Phone (775) 786-3040

Hospital & facility affiliations

  • Renown South Meadows Medical Center Hospital, Reno, NV, CCN 290049
  • Renown Regional Medical Center Hospital, Reno, NV, CCN 290001

Merit-based Incentive Payment System (MIPS)

Final score
90.71 of 100Reported as apm
Quality
81.42
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA10084NVMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Reno Orthopaedic Clinic, LTD Physician Assistant CurrentSince Mar 18, 2013 Accepting new patients
Reno Orthopaedic Clinic, LTD Physician Assistant CurrentSince Mar 18, 2013 Accepting new patients
Renown Regional Medical Center Past Accepting new patients
Reno Orthopaedic Clinic, LTD Physician Assistant Past Accepting new patients
Reno Orthopaedic Surgery Center LLC PastSince Mar 7, 2021 Accepting new patients
Dignity Health Past Accepting new patients

Locations

555 N Arlington Ave
Reno, NV 89503

555 N Arlington Ave
Bldg C
Reno, NV 89503

Interoperability endpoints

  • Direct secure messaging: nnicolet85491@direct.renown.org
  • Direct secure messaging: nnicolet24795@renoorthopediccenter.gardenplotortho.direct-ci.com
  • Direct secure messaging: nnicolet422281@direct.med.utah.edu

Organizations & group practices 6

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.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1200441600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1651104000000",
    "number": "1861678153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "555 N ARLINGTON AVE",
            "city": "RENO",
            "state": "NV",
            "postal_code": "895034723",
            "telephone_number": "775-786-3040",
            "fax_number": "775-786-1887"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "555 N ARLINGTON AVE",
            "city": "RENO",
            "state": "NV",
            "postal_code": "895034723",
            "telephone_number": "775-786-3040",
            "fax_number": "775-788-5216"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICOLET",
        "first_name": "NATHAN",
        "middle_name": "LEE",
        "credential": "P.A.-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-01-16",
        "last_updated": "2022-04-28",
        "certification_date": "2022-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "NV",
            "license": "PA10084",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "12227280",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1861678153",
            "state": "NV"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "nnicolet85491@Direct.renown.org",
            "affiliation": "N",
            "address_1": "555 N Arlington Ave",
            "city": "Reno",
            "state": "NV",
            "country_code": "US",
            "postal_code": "895034723",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Reno, NV

Sources for this page

Verify at the official NPI Registry.