Jeremy Nicoloff, PA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

PA52946 Issued in CA

Practice address

1501 Trousdale Dr FL 1
Burlingame, CA 94010-4506

Phone

(650) 652-8700

Fax

(650) 652-8705

NPI assigned

Nov 5, 2015

Last updated

May 6, 2016By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• North Shore-Lij Medical PC

  dba NHPP Cardiology at Great Neck

  • Urology Physician
  • Great Neck, NY
  • NPI 1053688572
  Medicare reassignment NPD

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

{
    "created_epoch": "1446681600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1462492800000",
    "number": "1912370305",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "577 AIRPORT BLVD STE 300",
            "city": "BURLINGAME",
            "state": "CA",
            "postal_code": "940102048",
            "telephone_number": "650-240-8198"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 TROUSDALE DR FL 1",
            "city": "BURLINGAME",
            "state": "CA",
            "postal_code": "940104506",
            "telephone_number": "650-652-8700",
            "fax_number": "650-652-8705"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICOLOFF",
        "first_name": "JEREMY",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-11-05",
        "last_updated": "2016-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "CA",
            "license": "PA52946",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Janet Nguyen
• Michelle Phuong-Uyen Nguyen, PT, DPT
• Thinh Timothy Nguyen, DPT
• Uyen Kim Nguyen, DPT
• Siyuan Ni, M.D.
• Ning Ning, M.D.
• Esi Wusiwa Nkyekyer, MD, MPH
• Michael Northcutt, M.D.
• Northern California Primary Care
• Northern Peninsula Infectious Diseases Medical Group

• Surgical Physician Assistant in Burlingame, CA
• Providers in Burlingame, CA by specialty
• Surgical Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2016; 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.