Jesse Nichols, DO is a medicare enrolled "Emergency Medicine" physician in Joint Base Langley-eustis, Virginia. His current practice location is
633d Medical Group/sghc, 77 Nealy Ave, Joint Base Langley-eustis, Virginia. You can reach out to his office (for appointments etc.) via phone at
(757) 764-6800.
Jesse Nichols is licensed to practice in Ohio (license number 34.012968) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1891188892.
Physician's Profile
| Full Name | Jesse Nichols |
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| Gender | Male |
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| Speciality | Emergency Medicine |
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| Location | 633d Medical Group/sghc, Joint Base Langley-eustis, 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: 1891188892
- Provider Enumeration Date: 03/15/2015
- Last Update Date: 07/18/2019
Medicare PECOS Information:
- PECOS PAC ID: 2264722503
- Enrollment ID: I20220620001893
Medical Identifiers
Medical identifiers for Jesse Nichols such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1891188892 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 207P00000X | Emergency Medicine | 0102205683 (Virginia) | Secondary |
| 390200000X | Student In An Organized Health Care Education/training Program | (* (Not Available)) | Secondary |
| 207P00000X | Emergency Medicine | 34.012968 (Ohio) | 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. Jesse Nichols allows following entities to bill medicare on his behalf.
| Entity Name | Community Hospital Of Anaconda |
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| Entity Type | Part A Provider - Critical Access Hospital |
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| Entity Identifiers | NPI Number: 1205887924
PECOS PAC ID: 8123938974
Enrollment ID: O20030507000045 |
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| Entity Name | Community Hospital Of Anaconda |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1538597703
PECOS PAC ID: 8123938974
Enrollment ID: O20031119000745 |
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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. Jesse 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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Jesse Nichols, DO
112 Low St,
Butte, MT 59701-7633
Ph: () - | Jesse Nichols, DO
633d Medical Group/sghc, 77 Nealy Ave,
Joint Base Langley-eustis, VA 23665-2040
Ph: (757) 764-6800 |
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