Courtney Nicholas, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

NOT YET ISSUED Issued in CA

Practice address

101 The City Dr S # 4482
Orange, CA 92868-3201

Phone

(714) 456-5631

Fax

(714) 456-6660

NPI assigned

Nov 4, 2008

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

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

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.

• Children'S Hospital Los Angeles Medical Group, Inc.

  • Multi-Specialty Clinic/Center
  • Los Angeles, CA
  • NPI 1265530653

  Pediatrics

  Medicare reassignment NPD
• Southern California Permanente Medical Group

  • Health Maintenance Organization
  • Baldwin Park, CA
  • NPI 1770515280
  Medicare reassignment NPD
• Southern California Permanente Medical Group

  • Health Maintenance Organization
  • San Diego, CA
  • NPI 1225060742
  NPD
• Southern California Permanente Medical Group

  • Health Maintenance Organization
  • Santa Clarita, CA
  • NPI 1316409410
  NPD
• Children'S Hospital Los Angeles

  • Children's Chronic Disease Hospital
  • Los Angeles, CA
  • NPI 1366527954
  NPD (past)

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

{
    "created_epoch": "1225756800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638316800000",
    "number": "1902059934",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 THE CITY DR S # 4482",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928683201",
            "telephone_number": "714-456-5631",
            "fax_number": "714-456-6660"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 THE CITY DR S # 4482",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928683201",
            "telephone_number": "714-456-5631",
            "fax_number": "714-456-6660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICHOLAS",
        "first_name": "COURTNEY",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-11-04",
        "last_updated": "2021-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "NOT YET ISSUED",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "4647 Zion Ave",
            "city": "San Diego",
            "state": "CA",
            "country_code": "US",
            "postal_code": "921202507",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Vivian Nguyen
• William Tan Nguyen, M.D.
• Relinthis Ngwafa, NP
• Nhaque Dental Corporation
• Karen Ni, OTD, OTR/L
• Roman Isaia Nichols-Dunlap
• Ivan Nichols, M.D.
• Lori Marie Nichols, RRT
• Shannon Leigh Nichols, LCSW
• Shawn Marie Nichols, AGACNP-BC

• Pediatrics Physician in Orange, CA
• Providers in Orange, CA by specialty
• Pediatrics Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2021; 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.