DR. SHANTRICE BERNICE NICHOLS-BATES (DNP, FNP-C) – Family Nurse Practitioner, NPI 1245603844
Family Nurse Practitioner
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Doctor Profile
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Profile Insights
NPPES metrics only — not quality of care.
3,379 NURSE PRACTITIONER in OR
Provider Addresses for DR. SHANTRICE BERNICE NICHOLS-BATES (DNP, FNP-C)
2280 MARCOLA RD
SPRINGFIELD, OR 974772594
Phone: (541) 747-4300
Fax: (541) 747-0655
Type: Mailing
126 N PARK DR
FAYETTEVILLE, GA 302141645
Phone: (470) 470-2718
Fax: (678) 519-2736
Type: Mailing
123A HIGHWAY 80 E
CLINTON, MS 390564738
Phone: (769) 366-2659
Type: Mailing
350 W WOODROW WILSON AVE STE 1010
JACKSON, MS 392137681
Phone: (769) 366-2659
Type: Location
4550 JONESBORO RD STE A2-314
UNION CITY, GA 302912050
Phone: (470) 316-8028
Type: Mailing
5835 CAMPBELLTON RD SW
ATLANTA, GA 303318013
Phone: (404) 696-4141
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 1 Open Payments records for all available years, with a total value of $17.
Total Amount is formed as General ($17) + Research ($0) + Ownership ($0) = $17.
Last reported payment date: 2023-02-15 • Largest payer in this snapshot: Novo Nordisk Inc ($17).
Total Amount
$17
General + Research + Ownership
Payments
1
Total payment records
General Amount
$17
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2023-02-15
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Novo Nordisk Inc | $17 |
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: 2021-04-07
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 2 Medicare enrollment records; no due dates published yet.
Enrollment records
2
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 |
|---|---|---|---|---|
| I20170523000087 | I | Nurse Practitioner | MS | TBD |
| I20210407000365 | I | Nurse Practitioner | GA | 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 97477)
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