Thedra E Nichols, FNP is a medicare enrolled "Nurse Practitioner - Family" physician in Charlottesville, Virginia. Her current practice location is
1215 Lee St, Charlottesville, Virginia. You can reach out to her office (for appointments etc.) via phone at
(434) 924-0000.
Thedra E Nichols is licensed to practice in Virginia (license number 0024166152) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1427055011.
Physician's Profile
| Full Name | Thedra E Nichols |
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| Gender | Female |
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| Speciality | Nurse Practitioner - Family |
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| Location | 1215 Lee St, Charlottesville, Virginia |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1427055011
- Provider Enumeration Date: 06/28/2005
- Last Update Date: 04/17/2023
Medicare PECOS Information:
- PECOS PAC ID: 1658336953
- Enrollment ID: I20041129000611
Medical Identifiers
Medical identifiers for Thedra E Nichols such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1427055011 | NPI | - | NPPES |
| 010104661 | Medicaid | VA | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 207Q00000X | Family Medicine | 0024166152 (Virginia) | Secondary |
| 363LF0000X | Nurse Practitioner - Family | 0024166152 (Virginia) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Thedra E Nichols allows following entities to bill medicare on her behalf.
| Entity Name | University Of Virginia Physicians Group |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1033138250
PECOS PAC ID: 4880590728
Enrollment ID: O20040102000780 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Thedra E Nichols is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Thedra E Nichols, FNP
Po Box 9007,
Charlottesville, VA 22906-9007
Ph: () - | Thedra E Nichols, FNP
1215 Lee St,
Charlottesville, VA 22908-0816
Ph: (434) 924-0000 |
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