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NICHOLAS WENDELL WICKERSHAM M.D. NPI 1396867222


NPI Information

NPI: 1396867222
Provider Name: NICHOLAS WENDELL WICKERSHAM, M.D.
Classification: Radiology - 2085R0202X
Entity Type: Individual

Specialization: Diagnostic Radiology

Organization: BOULDER RADIOLOGISTS INC PC

PECOS Registration: Yes

Address:
1100 BALSAM AVE
BOULDER, CO
ZIP 80304
Phone: (303) 532-3500
Get Directions

Nicholas Wendell Wickersham, M.D. is a diagnostic radiology radiology in Boulder, CO with 21 years of experience. The provider is a radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. Nicholas Wendell Wickersham, M.D. NPI is 1396867222. The provider is registered as an individual entity type and is a single specialty group.

The NPPES NPI record indicates the provider is a male.

Education
Medical School: UNIVERSITY OF WASHINGTON SCHOOL OF MEDICINE
Graduation Year:2003

The provider's business location address is:

1100 BALSAM AVE
BOULDER, CO
ZIP 80304-404
Phone: (303) 532-3500

The NPI 1396867222 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The following top HCPCS codes were publicly reported for this provider under the Medicare program for the year 2016. The reported codes are based on the top codes for each available Medicare specialty, excluding evaluation and management codes.

  • X-ray of chest, 2 views, front and side (HCPCS:71020)
  • X-ray of chest, 1 view, front (HCPCS:71010)
  • CT scan of abdomen and pelvis with contrast (HCPCS:74177)
  • Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers (HCPCS:93971)
  • Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck (HCPCS:93880)
  • X-ray of abdomen, single view (HCPCS:74000)
  • X-ray of ribs of one side of body, minimum of 2 views (HCPCS:73510)
  • X-ray of foot, minimum of 3 views (HCPCS:73630)
  • CT scan of abdomen and pelvis (HCPCS:74176)
  • X-ray of wrist, minimum of 3 views (HCPCS:73110)
  • X-ray of knee, 4 or more views (HCPCS:73564)
  • Nuclear medicine study with CT imaging skull base to mid-thigh (HCPCS:78815)
  • X-ray of shoulder, minimum of 2 views (HCPCS:73030)
  • X-ray of knee, 3 views (HCPCS:73562)
  • Ultrasound of head and neck (HCPCS:76536)
  • Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers (HCPCS:93970)
  • Ultrasound pelvis through vagina (HCPCS:76830)
  • Ultrasound guidance for accessing into blood vessel (HCPCS:76937)
  • Nuclear medicine study of vessels of heart using drugs or exercise multiple studies (HCPCS:78452)
  • X-ray of hand, minimum of 3 views (HCPCS:73130)
  • Fluoroscopic guidance for insertion, replacement or removal of central venous access device (HCPCS:77001)

The enumeration date for this NPI number is 4/3/2007 and was last updated on 3/15/2021.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
12085R0202XRadiologyDiagnostic Radiology47842COLORADOYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
107101759MEDICAIDCOLORADO

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.