Jesse Nichols, DO

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

34.012968 Issued in OH

Practice address

633D Medical Group/SGHC
77 Nealy Ave
Joint Base Langley-Eustis, VA 23665-2040

Phone

(757) 764-6800

NPI assigned

Mar 15, 2015

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in MT

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 Osteopathy

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.

• Community Hospital of Anaconda

  • Critical Access Hospital
  • Anaconda, MT
  • NPI 1205887924
  Medicare reassignment NPD
• Community Hospital of Anaconda

  • Family Medicine Physician
  • Anaconda, MT
  • NPI 1538597703
  Medicare reassignment NPD
• Community Hospital of Anaconda

  • Surgery Physician
  • Anaconda, MT
  • NPI 1023623675
  NPD
• Community Hospital of Anaconda

  • Family Medicine Physician
  • Butte, MT
  • NPI 1205239076
  NPD
• Community Hospital of Anaconda

  • Family Medicine Physician
  • Anaconda, MT
  • NPI 1336244797
  NPD

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

{
    "created_epoch": "1426377600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1563408000000",
    "number": "1891188892",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "112 LOW ST",
            "city": "BUTTE",
            "state": "MT",
            "postal_code": "597017633"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "633D MEDICAL GROUP/SGHC",
            "address_2": "77 NEALY AVE",
            "city": "JOINT BASE LANGLEY-EUSTIS",
            "state": "VA",
            "postal_code": "236652040",
            "telephone_number": "757-764-6800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICHOLS",
        "first_name": "JESSE",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-03-15",
        "last_updated": "2019-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "VA",
            "license": "0102205683",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "OH",
            "license": "34.012968",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mary Iskarous, PSY.D.
• Shawna Green Kuhn, DO
• Katherine M McCroary, MD
• Kimberly R Moser, PMHNP
• Sean Lee Murphy, MD
• Denise Nielson, SLP
• Mary Boseman Powell, PHARMD
• Selena A Rogers, LCSW
• Michael Scharf
• Diana Elise Strain, LCSW

• Emergency Medicine Physician in Joint Base Langley-Eustis, VA
• Providers in Joint Base Langley-Eustis, VA by specialty
• Emergency Medicine Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2019; 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.