Jonathan Matthew Nickoloff, M.D,

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

MD00044271 Issued in WA

Practice address

9922 N Nevada St
Spokane, WA 99218-1126

Phone

(509) 747-6194

Fax

(509) 838-0824

NPI assigned

May 27, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WA

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

Specialty

General SurgeryAlso: Thoracic Surgery

Education

Creighton University School of Medicine, 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Providence Health and Services WashingtonGroup PAC ID 0345139929, 778 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Prov Sacred HRT Med Ctr & Childs Hosp. Hospital, Spokane, WA, CCN 500054
• Providence Holy Family Hospital Hospital, Spokane, WA, CCN 500077
• Providence Mount Carmel Hospital Hospital, Colville, WA, CCN 501326

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Providence Health & Services Washington

  • Pulmonary Disease Physician
  • Spokane, WA
  • NPI 1194099390
  Medicare reassignment Care Compare group NPD
• Columbia Surgical Specialists, PS

  • Surgery Physician
  • Spokane, WA
  • NPI 1417067372
  Medicare reassignment NPD
• Columbia Surgical Specialists, PS

  • Ambulatory Surgical Clinic/Center
  • Spokane, WA
  • NPI 1477617751
  NPD
• Providence Health & Services Washington

  • Family Medicine Physician
  • Colville, WA
  • NPI 1083968879
  NPD
• Providence Health & Services - Wa

  • General Acute Care Hospital
  • Spokane, WA
  • NPI 1144471715
  NPD (past)
• Providence Health & Services - Washington

  • Substance Use Disorder Rehabilitation Hospital Unit
  • Hoquiam, WA
  • NPI 1043374119
  NPD (past)
• Providence Health & Services - Washington

  • General Acute Care Hospital
  • Spokane, WA
  • NPI 1225289895
  NPD (past)
• Surgical Specialists of Spokane

  • Surgery Physician
  • Spokane, WA
  • NPI 1013989532
  NPD (past)

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

• Providence Health & Services - Wa

  • General Acute Care Hospital
  • Spokane, WA
  • NPI 1144471715
  Care Compare affiliation
• Providence Health & Services - Washington

  • Critical Access Hospital
  • Colville, WA
  • NPI 1003067679
  Care Compare affiliation
• Providence Health & Services - Washington

  • General Acute Care Hospital
  • Spokane, WA
  • NPI 1225289895
  Care Compare affiliation

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

{
    "created_epoch": "1148688000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1669680000000",
    "number": "1891742664",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 421",
            "city": "LIBERTY LAKE",
            "state": "WA",
            "postal_code": "990190421",
            "telephone_number": "866-747-2455",
            "fax_number": "509-227-7070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9922 N NEVADA ST",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992181126",
            "telephone_number": "509-747-6194",
            "fax_number": "509-838-0824"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICKOLOFF",
        "first_name": "JONATHAN",
        "middle_name": "MATTHEW",
        "name_prefix": "Dr.",
        "credential": "M.D,",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-27",
        "last_updated": "2022-11-29",
        "certification_date": "2022-11-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "WA",
            "license": "MD00044271",
            "primary": true
        },
        {
            "code": "208C00000X",
            "taxonomy_group": "",
            "desc": "Colon & Rectal Surgery",
            "state": "WA",
            "license": "MD00044271",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8449159",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• John Nickerson
• Sandra Kay Nickerson, ADN, RN
• Zita Lindell Nickeson, M.ED
• James Nickleson, CRNA
• Johnna Nickoloff, MSW, LICSWA
• Lyda Erin Nicodemus, ARNP
• Alyson Nicol, LICSW
• Kylie Niedermeyer, PSYD
• Andrea D Niehoff, CMA
• Elizabeth Ann Nielsen

• Surgery Physician in Spokane, WA
• Providers in Spokane, WA by specialty
• Surgery Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2022; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.