BRUCE GREENWOOD NICKERSON (NPI# 1215026521) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1215026521 |
| Entity Type | Individual |
| Full Name | BRUCE GREENWOOD NICKERSON |
| Credential | MD |
| Practice Address |
455 S Main St Orange CA 92868-3835 |
| Practice Telephone | 7145328620 |
| Practice Fax Number | 7142894072 |
| Mailing Telephone | 7142894511 |
| Mailing Fax Number | 7142894788 |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2008-08-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2080N0001X |
Pediatrics Specialization: Neonatal-Perinatal Medicine |
G38843 | CA | Allopathic & Osteopathic Physicians |
| Y | 2080P0214X |
Pediatrics Specialization: Pediatric Pulmonology |
G38843 | CA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | 00G388430 | 05 | |
| CA | MEDICARE PTAN | WG38843F | 01 |
| Street Address |
455 S MAIN ST |
| City | ORANGE |
| State | CA |
| Zip Code | 92868-3835 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033191473 | Nancy Ann Varni | Nurse Practitioner | 455 S Main St, Orange, CA 92868-3835 | 2005-11-18 |
| 1265776587 | Victor Wang | Pediatrics | 455 S Main St, Orange, CA 92868-3835 | 2012-11-27 |
| 1487906152 | Nancy Kuntz | Nurse Practitioner | 455 S Main St, Orange, CA 92868-3835 | 2012-10-05 |
| 1023360914 | Youngeun Park | Pediatrics | 455 S Main St, Orange, CA 92868-3835 | 2012-10-03 |
| 1295085918 | Stacey Jannette Bass | Nurse Practitioner | 455 S Main St, Orange, CA 92868-3835 | 2012-09-11 |
| 1003165267 | Jennifer Michelle Shively | Nurse Practitioner | 455 S Main St, Orange, CA 92868-3835 | 2012-09-04 |
| 1437406014 | Heidi Rens | Pharmacist | 455 S Main St, Orange, CA 92868-3835 | 2012-08-13 |
| 1992065361 | Jina Lim | Pediatrics | 455 S Main St, Orange, CA 92868-3835 | 2012-05-20 |
| 1386901700 | Elizabeth Marie Torok | Nurse Practitioner | 455 S Main St, Orange, CA 92868-3835 | 2012-04-23 |
| 1942578117 | Cassandra Lynn Stewart | Pediatrics | 455 S Main St, Orange, CA 92868-3835 | 2011-12-02 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346859386 | Sadaf Abrishami | Pharmacist | 101 The City Dr S., Orange, CA 92868 | 2020-07-27 |
| 1245869825 | Helena Yijia Hong | Student in an Organized Health Care Education/Training Program | Uci Medical Center, 101 The City Drive, Orange, CA 92868 | 2020-04-06 |
| 1932736527 | Joshua Kristopher Livingston | Student in an Organized Health Care Education/Training Program | 101 The City Dr S, Rte. 128-01, Orange, CA 92868 | 2020-03-24 |
| 1831725894 | Michelle Brown | Student in an Organized Health Care Education/Training Program | 101 The City Dr S. Rte 128-01, Orange, CA 92868 | 2020-03-20 |
| 1093363491 | Kristin Lee | Pharmacist | 132 S. Anita Dr., Orange, CA 92868 | 2019-08-28 |
| 1740834217 | Matthew Brian Mecheal | Dentist | 725 W. La Veta Suite 260, Orange, CA 92868 | 2019-08-01 |
| 1245897990 | Brent Tyler Louie | Student in an Organized Health Care Education/Training Program | 101 The City Drive South Building 3, Route 88, Neuropsychiatric Center Uc Irvine Medical Center, Orange, CA 92868 | 2019-05-28 |
| 1093277972 | Danielle Amato | Student in an Organized Health Care Education/Training Program | Uc Irvine Health 101 The City Drive, City Tower, Ste 40, Orange, CA 92868 | 2019-04-01 |
| 1851852206 | Julia Ting Bu | Student in an Organized Health Care Education/Training Program | Uc Irvine Health, 101 The City Drive, City Tower, Ste 400, Orange, CA 92868 | 2019-03-28 |
| 1326507344 | Harrison Beene Lowder | Student in an Organized Health Care Education/Training Program | 505 S. Main St, Suite 525, Orange, CA 92868 | 2019-03-19 |
| Find all providers in zip 92868 | ||||
| Taxonomy Code | 2080P0214X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Pediatric Pulmonology |
| A pediatrician dedicated to the prevention and treatment of all respiratory diseases affecting infants, children and young adults. This specialist is knowledgeable about the growth and development of the lung, assessment of respiratory function in infants and children, and experienced in a variety of invasive and noninvasive diagnostic techniques. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) was provided by the American Osteopathic Board of Pediatrics. The Certification is no longer offered. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720321656 | Children's Hospital of Orange County | Pediatrics | 1201 W La Veta Ave, Orange, CA 92868-4203 | 2013-03-28 |
| 1023364692 | Hanna Hong | Pediatrics | 1201 W La Veta Ave, Orange, CA 92868-4203 | 2012-07-31 |
| 1265633887 | Kim D Lu | Pediatrics | 333 City Blvd W, Suite 800, Orange, CA 92868-2903 | 2007-05-30 |
| 1831279926 | Daniel M Cooper | Pediatrics | Uci Medical Center, 101 The City Drive South, Orange, CA 92868 | 2006-10-16 |
| 1700972536 | Anchalee Yuengsrigul | Pediatrics | 455 S Main St, Orange, CA 92868-3835 | 2006-10-05 |
| 1851485627 | David A. Hicks | Pediatrics | 455 S Main St, Orange, CA 92868-3835 | 2006-10-03 |
| 1427085810 | Pornchai Tirakitsoontorn | Pediatrics | 455 S Main St, Orange, CA 92868-3835 | 2006-06-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659532117 | Salman Raza Khan | Pediatrics | 65 N Madison Ave Ste 701, Pasadena, CA 91101-2046 | 2008-06-18 |
| 1932384682 | University Childrens Medical Group | Pediatrics | 4650 W Sunset Blvd # 83, Los Angeles, CA 90027-6062 | 2007-12-31 |
| 1912188053 | Sebnem Ozdogan | Pediatrics | 3525 Pelandale Ave, Modesto, CA 95356-9781 | 2007-11-16 |
| 1316165384 | Cesar Chavarria, Md, Inc | Pediatrics | 18425 Burbank Blvd Suite 719, Tarzana, CA 91356 | 2007-04-23 |
| 1528184603 | Muhammad M. Saeed | Pediatrics | 4700 W Sunset Blvd Fl 3, Kaiser Permanente Dept of Pediatrics, Los Angeles, CA 90027-6082 | 2007-03-21 |
| 1528194024 | Alan Howard Cohen | Pediatrics | 3180 Porter Dr, Palo Alto, CA 94304-1212 | 2007-02-26 |
| 1720164080 | Carlos Eduardo Milla | Pediatrics | 770 Welch Rd Ste 350, Stanford University, Palo Alto, CA 94304-1523 | 2006-10-30 |
| 1992892822 | Amy Nevin Harrison | Pediatrics | 1501 Superior Ave Ste 202, Newport Beach, CA 92663-3640 | 2006-10-10 |
| 1659468759 | Christopher Endom Harris | Pediatrics | 8700 Beverly Blvd # Nt-4230, West Hollywood, CA 90048-1804 | 2006-10-09 |
| 1760580062 | Arnold C.g. Platzker | Pediatrics | 4650 W. Sunset Blvd, Los Angeles, CA 90027 | 2006-09-20 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.