Michael Nickerson, NP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

033993-23-03 Issued in NH

Practice address

333 Borthwick Ave
Emergency Department
Portsmouth, NH 03801-7128

Phone

(603) 433-4012

Fax

(603) 433-5184

NPI assigned

Aug 5, 2006

Last updated

Aug 10, 2012By 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

Other identifiers 5

Medicare fee-for-service enrollment

Enrolled in NH

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

Specialty

Nurse Practitioner

Education

Other, 1995

Medicare assignment

May accept Medicare assignment

Group practices

Clearchoicemd, PLLCGroup PAC ID 1850510058, 85 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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.

• Clearchoicemd, PLLC

  • Urgent Care Clinic/Center
  • Berlin, VT
  • NPI 1851722417

  NH

  Medicare reassignment Care Compare group NPD
• Clearchoicemd, PLLC

  • Urgent Care Clinic/Center
  • Alton, NH
  • NPI 1720705403
  NPD
• Emergency Physicians of Derry PLLC

  • Emergency Medical Services (Emergency Medicine) Physician
  • Derry, NH
  • NPI 1730232232
  NPD (past)
• Exeter Emergency Physicians PA

  • Emergency Medical Services (Emergency Medicine) Physician
  • Exeter, NH
  • NPI 1497845101
  NPD (past)
• Portsmouth Emergency Physicians PC

  • Emergency Medical Services (Emergency Medicine) Physician
  • Portsmouth, NH
  • NPI 1710923511
  NPD (past)

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

{
    "created_epoch": "1154736000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1344556800000",
    "number": "1942219381",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "333 BORTHWICK AVE",
            "address_2": "EMERGENCY DEPARTMENT",
            "city": "PORTSMOUTH",
            "state": "NH",
            "postal_code": "038017128",
            "telephone_number": "603-433-4012",
            "fax_number": "603-433-5184"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "333 BORTHWICK AVE",
            "address_2": "EMERGENCY DEPARTMENT",
            "city": "PORTSMOUTH",
            "state": "NH",
            "postal_code": "038017128",
            "telephone_number": "603-433-4012",
            "fax_number": "603-433-5184"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICKERSON",
        "first_name": "MICHAEL",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-05",
        "last_updated": "2012-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NH",
            "license": "033993-23-03",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "930112668",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "4007290Y0NH01",
            "state": "NH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0711608",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30011603",
            "state": "NH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "247490099",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nhoms, PLLC (Nhoms)
• Arlene Nichols, CPHT
• Valerie Nichols, PT, DPT
• Anita L Nicholson, APRN
• Tammy Anne Nicholson, LCMHC
• Kurt Raymond Niebauer
• Janelle Niesse
• Mayo Andrew Noerdlinger, MD
• Kerry Nolte, APRN
• Alexander G Noonan-Shueh, MD

• Nurse Practitioner in Portsmouth, NH
• Providers in Portsmouth, NH by specialty
• Nurse Practitioner in New Hampshire

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2012; 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.