Dr Nicholas Matthew Wisdom, PHD is a medicare enrolled "Clinical Neuropsychologist" provider in Houston, Texas. His current practice location is
1300 Bay Area Blvd Ste B150-15, Houston, Texas. You can reach out to his office (for appointments etc.) via phone at
(281) 954-6828.
Dr Nicholas Matthew Wisdom is licensed to practice in Kansas (license number 2032) 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 1912260779.
Healthcare Provider's Profile
| Full Name | Dr Nicholas Matthew Wisdom |
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| Gender | Male |
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| Speciality | Clinical Neuropsychologist |
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| Location | 1300 Bay Area Blvd Ste B150-15, Houston, Texas |
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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: 1912260779
- Provider Enumeration Date: 06/18/2012
- Last Update Date: 04/21/2025
Medicare PECOS Information:
- PECOS PAC ID: 9032441191
- Enrollment ID: I20191031002778
Medical Identifiers
Medical identifiers for Dr Nicholas Matthew Wisdom such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1912260779 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 103TC0700X | Psychologist - Clinical | 2032 (Kansas) | Secondary |
| 103G00000X | Clinical Neuropsychologist | 2032 (Kansas) | 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. Dr Nicholas Matthew Wisdom allows following entities to bill medicare on his behalf.
| Entity Name | Neurocognitive Specialty Group Pllc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1346700275
PECOS PAC ID: 9133451297
Enrollment ID: O20191023001459 |
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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. Dr Nicholas Matthew Wisdom 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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Dr Nicholas Matthew Wisdom, PHD
15222 Woodhorn Dr,
Houston, TX 77062-3211
Ph: (405) 205-8405 | Dr Nicholas Matthew Wisdom, PHD
1300 Bay Area Blvd Ste B150-15,
Houston, TX 77058-2505
Ph: (281) 954-6828 |
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