NICHOLAS WENDELL WICKERSHAM (M.D.) – Diagnostic Radiology Physician, NPI 1396867222
Diagnostic Radiology Physician
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Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
229 INTERVENTIONAL RADIOLOGY in CO
Provider Addresses for NICHOLAS WENDELL WICKERSHAM (M.D.)
4747 Arapahoe Ave
Boulder, CO 803031131
Phone: (877) 465-0012
Type: Location
36 GARDEN CTR
BROOMFIELD, CO 800201730
Phone: (303) 465-0401
Fax: (303) 438-1351
Type: Mailing
1100 BALSAM AVE
BOULDER, CO 803043404
Phone: (303) 532-3500
Type: Location
42 GARDEN CTR
BROOMFIELD, CO 800201730
Phone: (303) 465-0401
Fax: (303) 438-1351
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 2 Open Payments records for all available years, with a total value of $37.
Total Amount is formed as General ($37) + Research ($0) + Ownership ($0) = $37.
Last reported payment date: 2024-05-23 • Largest payer in this snapshot: HeartFlow, Inc. ($37).
Total Amount
$37
General + Research + Ownership
Payments
2
Total payment records
General Amount
$37
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-05-23
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| HeartFlow, Inc. | $37 |
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2009-07-24
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20090724000109 | I | Diagnostic Radiology | CO | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 71045 | X-ray of chest, 1 view | 342 | 300 | $0 |
| 77067 | Screening mammography | 207 | 207 | $0 |
| 77063 | Screening 3d breast mammography | 207 | 207 | $0 |
| 77085 | Dxa bone density measurement of hip, pelvis, spine including spine fracture assessment | 173 | 173 | $0 |
| 77092 | Interpretation of trabecular bone score (tbs) and report on fracture risk | 172 | 172 | $0 |
Insurance plans in this area (ZIP 80303)
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Provider's Procedures
| Specialty | Practice State | HCPCS Code | Description | Service Count | Beneficiary Count |
|---|---|---|---|---|---|
| DIAGNOSTIC RADIOLOGY | CO | 73110 | X-ray of wrist, minimum of 3 views | 26 | 24 |
| DIAGNOSTIC RADIOLOGY | CO | 73562 | X-ray of knee, 3 views | 35 | 29 |
| DIAGNOSTIC RADIOLOGY | CO | 74177 | CT scan of abdomen and pelvis with contrast | 138 | 134 |
| DIAGNOSTIC RADIOLOGY | CO | 78452 | Nuclear medicine study of vessels of heart using drugs or exercise multiple studies | 16 | 16 |
| DIAGNOSTIC RADIOLOGY | CO | 93971 | Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers | 87 | 86 |
Group practice members
| Name | Specialty | State |
|---|---|---|
| Diagnostic Radiology | CA | |
| - | CO | |
| Diagnostic Radiology | CO | |
| Diagnostic Radiology, Interventional Radiology | CO | |
| Diagnostic Radiology, Interventional Radiology, Nuclear Medicine | CO | |
| Diagnostic Radiology, Interventional Radiology, Nuclear Medicine | CO | |
| Diagnostic Radiology | CO | |
| Diagnostic Radiology | CO | |
| Interventional Radiology, Diagnostic Radiology, Nuclear Medicine | CO | |
| Diagnostic Radiology | AR |
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