NICHOLAS WENDELL WICKERSHAM M.D. NPI 1396867222

NPI Information

  • NPI: 1396867222
  • Provider Name: NICHOLAS WENDELL WICKERSHAM, M.D.
  • Classification: Radiology - 2085R0202X
  • Specialization: Diagnostic Radiology
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 1100 BALSAM AVE
    BOULDER, CO
    ZIP 80304
  • Phone: (303) 532-3500

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NPI Details

Nicholas Wendell Wickersham, M.D. is a diagnostic radiology radiology in Boulder, CO with 23 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, 1 view (HCPCS:71045)
  • Ct scan of abdomen and pelvis with contrast (HCPCS:74177)
  • Ct scan head or brain without contrast (HCPCS:70450)
  • Screening 3d breast mammography (HCPCS:77063)
  • Screening mammography (HCPCS:77067)
  • X-ray of chest, 2 views (HCPCS:71046)
  • Interpretation of trabecular bone score (tbs) and report on fracture risk (HCPCS:77092)
  • Dxa bone density measurement of hip, pelvis, spine including spine fracture assessment (HCPCS:77085)
  • Ct scan of chest with contrast (HCPCS:71260)
  • Ct scan of blood vessels of chest with contrast (HCPCS:71275)
  • 3d radiographic procedure with computerized image postprocessing (HCPCS:76377)
  • Ultrasound study of one arm or leg veins with compression and maneuvers (HCPCS:93971)
  • Ultrasound of both sides of head and neck blood flow (HCPCS:93880)
  • Mri scan of pelvis before and after contrast (HCPCS:72197)
  • Ct scan of chest without contrast (HCPCS:71250)
  • 3d radiographic procedure (HCPCS:76376)
  • Ct scan of upper spine without contrast (HCPCS:72125)
  • Mri scan of brain without contrast (HCPCS:70551)
  • Ct scan of blood vessels of head with contrast (HCPCS:70496)
  • Ct scan of blood vessels of neck with contrast (HCPCS:70498)
  • X-ray of lower and sacral spine, 2-3 views (HCPCS:72100)
  • Nuclear medicine study from skull base to mid-thigh with ct scan (HCPCS:78815)
  • Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to 77065 or 77066) (HCPCS:G0279)
  • X-ray of abdomen, 1 view (HCPCS:74018)
  • Ct scan of abdomen and pelvis without contrast (HCPCS:74176)
  • Limited ultrasound scan of abdomen (HCPCS:76705)
  • X-ray of hip, 2-3 views (HCPCS:73502)
  • X-ray of knee, 1-2 views (HCPCS:73560)
  • Imaging for evaluation of swallowing function (HCPCS:74230)
  • Limited ultrasound scan of 1 breast (HCPCS:76642)
  • X-ray of pelvis, 1-2 views (HCPCS:72170)
  • Diagnostic mammography of 1 breast (HCPCS:77065)
  • X-ray of shoulder, minimum of 2 views (HCPCS:73030)
  • Mri scan of brain before and after contrast (HCPCS:70553)
  • Ultrasound scan of head and neck soft tissue (HCPCS:76536)
  • Complete ultrasound scan behind abdominal cavity (HCPCS:76770)
  • Ultrasound study of arm or leg veins with compression and maneuvers (HCPCS:93970)
  • Complete ultrasound scan of abdomen (HCPCS:76700)
  • Mri scan of abdomen before and after contrast (HCPCS:74183)
  • X-ray of foot, minimum of 3 views (HCPCS:73630)
  • Ct scan of leg without contrast (HCPCS:73700)
  • Complete ultrasound scan of pelvis (HCPCS:76856)
  • Diagnostic mammography of both breasts (HCPCS:77066)
  • Nuclear medicine study of bone and/or joint whole body (HCPCS:78306)
  • Ct scan of blood vessels and grafts of heart with contrast (HCPCS:75574)
  • Ct scan of soft tissue of neck with contrast (HCPCS:70491)
  • Double contrast x-ray of esophagus (HCPCS:74221)
  • X-ray of knee, 3 views (HCPCS:73562)
  • X-ray of knee, 4 or more views (HCPCS:73564)
  • Nuclear medicine studies of heart muscle at rest and with stress and spect (HCPCS:78452)
  • Ultrasound scan of uterus, ovaries, tubes, cervix and pelvic area through vagina (HCPCS:76830)
  • X-ray of wrist, minimum of 3 views (HCPCS:73110)
  • X-ray of hand, minimum of 3 views (HCPCS:73130)
  • Ct scan of lower spine without contrast (HCPCS:72131)
  • X-ray of lower and sacral spine, minimum of 4 views (HCPCS:72110)
  • Mri scan of lower spinal canal without contrast (HCPCS:72148)
  • Limited ultrasound scan behind abdominal cavity (HCPCS:76775)
  • Nuclear medicine study whole body with ct scan (HCPCS:78816)
  • X-ray of ribs on side of body, minimum of 3 views (HCPCS:71101)
  • X-ray of ankle, minimum of 3 views (HCPCS:73610)
  • X-ray of abdomen, 2 views (HCPCS:74019)

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 Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
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 Identifier Other Provider Identifier Type Other Provider Identifier State Other 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: 11/21/2025

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