NICHOLAS ANDERSON (PA-C) – Physician Assistant, NPI 1093281016
Physician Assistant
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
1,534 PHYSICIAN ASSISTANT in ID
Provider Addresses for NICHOLAS ANDERSON (PA-C)
3100 Channing Way
Idaho Falls, ID 834047533
Phone: (706) 863-9595
Fax: (706) 868-8375
Type: Location
999 N Curtis Rd Ste 415
Boise, ID 837061334
Phone: (208) 302-2600
Fax: (208) 302-2625
Type: Location
East Goldstone Drive, Meridian, Ada County, Idaho, 83709, United States
MERIDIAN, ID 83642
Phone: (208) 302-7100
Fax: (208) 302-7155
Type: Mailing
315, Elm Street, Lockhart, Caldwell, Texas, 78644, United States
STE 100
CALDWELL, ID 83605
Phone: (208) 302-7100
Fax: (208) 302-7155
Type: Location
PO BOX 12358
AUGUSTA, GA 309142358
Phone: (706) 863-9595
Fax: (706) 868-8375
Type: Mailing
3100 CHANNING WAY
IDAHO FALLS, ID 834047533
Phone: (706) 863-9595
Fax: (706) 868-8375
Type: Location
PO BOX 190930
BOISE, ID 837190930
Phone: (208) 367-5170
Fax: (208) 367-5180
Type: Mailing
3200 CHANNING WAY STE 206
IDAHO FALLS, ID 834047546
Phone: (208) 529-2230
Fax: (208) 453-6142
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 8 Open Payments records for all available years, with a total value of $347.
Total Amount is formed as General ($347) + Research ($0) + Ownership ($0) = $347.
Last reported payment date: 2024-11-06 • Largest payer in this snapshot: Avita Medical Americas, LLC ($218).
Total Amount
$347
General + Research + Ownership
Payments
8
Total payment records
General Amount
$347
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-11-06
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Avita Medical Americas, LLC | $218 |
| Haemonetics Corporation | $65 |
| ABIOMED | $33 |
| Avita Medical Americas, Llc | $30 |
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: 2019-12-26
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 |
|---|---|---|---|---|
| I20191226000065 | I | Physician Assistant | ID | 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.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 83404)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Nurse Practitioner | GA | |
| Physician Assistant | ID | |
| Physician Assistant | ID | |
| General Surgery | GA | |
| General Surgery | ID | |
| Nurse Practitioner | ID | |
| General Surgery | GA | |
| General Surgery | GA | |
| Physician Assistant | ID | |
| Plastic And Reconstructive Surgery, General Surgery | ID |
Reviews
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