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NICKOLAS FEDACK DNP, CRNA
NPI 1124618061
Nurse Anesthetist, Certified Registered in El Paso, TX

Active since January 25, 2021
5005 N. PIEDRAS ST., EL PASO, TX 79920(915) 742-1970 Get Directions Write a Review

NPPES record last updated: July 19, 2023. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Jul 19, 2023, Jan 25, 2021 (2 updates tracked since 2021).

About Nickolas Fedack Dnp, Crna NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

NICKOLAS FEDACK DNP, CRNA (NPI 1124618061) is an individual nurse anesthetist, certified registered in El Paso, Texas, licensed in Texas (1087313) and active in the NPI registry since January 2021.

NPPES Registry Identity

NPI1124618061
Entity TypeIndividualMale
Primary Taxonomy367500000X
Provider Legal NameNICKOLAS FEDACKCredential: DNP, CRNA
Location Address5005 N. PIEDRAS ST.El Paso, TX 79920-5001
Mailing Address18511 Highlander Medics StFort Bliss, TX 79906-5327 · (915) 742-7777
Phone(915) 742-1970
Sole ProprietorNo
Enumeration DateJanuary 25, 2021
Last NPPES UpdateJuly 19, 20232 updates tracked since enumeration
NPPES CertifiedJuly 19, 2023
✔ NPI 1124618061 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyNurse Anesthetist, Certified RegisteredPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code367500000X
License✔ Licensed in TX · 1087313
Definition
(1) A licensed registered nurse with advanced specialty education in anesthesia who, in collaboration with appropriate health care professionals, provides preoperative, intraoperative, and postoperative care to patients and assists in management and resuscitation of critical patients in intensive care, coronary care, and emergency situations. Nurse anesthetists are certified following successful completion of credentials and state licensure review and a national examination directed by the Council on Certification of Nurse Anesthetists. (2) A registered nurse who is qualified by special training to administer anesthesia in collaboration with a physician or dentist and who can assist in the care of patients who are in critical condition.
Also ListedRegistered Nurse · Critical Care MedicineTaxonomy 163WC0200X · License RN.1638551 (CO)
5005 N. PIEDRAS ST., El Paso, TX 79920
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross and Blue Shield of Texas, Imperial Insurance Companies, Inc..Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Nickolas Fedack Dnp, Crna is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Medicare Billing Reassignments

3

Medicare enrollment records show Nickolas Fedack reassigns Medicare billing to 3 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

El Paso County Hospital District
3.1 mi
Ambulatory Surgical
4642 N MESA ST
El Paso, TX 79912
  • Reassigned Medicare billing, Texas enrollment
  • 409 clinicians in this Medicare group
NPI 1487547295 (915) 544-1200
El Paso Ams, PLLC
8.4 mi
Anesthesiology
2000 TRANS MOUNTAIN RD
El Paso, TX 79911
  • Reassigned Medicare billing, Texas enrollment
  • 196 clinicians in this Medicare group
NPI 1134740202 (915) 577-8467
Texas Ams PLLC
1,143 mi
Anesthesiology
28 N PALAFOX ST
Pensacola, FL 32502
  • Reassigned Medicare billing, Texas enrollment
  • 432 clinicians in this Medicare group
NPI 1174926125 (866) 653-2540

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. TYLER CLARE NICHOLSON MD
Orthopaedic Surgery
5005 N. PIEDRAS ST., WILLIAM BEAUMONT ARMY MEDICAL CENTER ATTN: GME
EL PASO, TX 79920
El Paso County (915) 742-2597
DR. KURTIS GLEN LIGHTHEART DMD
Dentist (Orthodontics and Dentofacial Orthopedics)
5005 N. PIEDRAS ST., DENTAC
EL PASO, TX 79920
El Paso County (915) 742-5935
MRS. VICKI ANN GANNON M.A.,CCC-SLP
Speech-Language Pathologist
5005 N. PIEDRAS ST.
EL PASO, TX 79920
El Paso County (915) 569-2073

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Nickolas Fedack's NPI number?

The NPI number for Nickolas Fedack is 1124618061. It was assigned to this individual provider in the NPPES registry on January 25, 2021.

Where is Nickolas Fedack located?

Nickolas Fedack practices at 5005 N. Piedras St., El Paso, TX 79920. The listed phone number is (915) 742-1970.

What is Nickolas Fedack's specialty?

The primary specialty registered for this NPI is Nurse Anesthetist, Certified Registered with taxonomy code 367500000X.

Is Nickolas Fedack enrolled in Medicare?

Yes. Nickolas Fedack is registered in the Medicare PECOS enrollment system.

Which organizations bill Medicare for Nickolas Fedack's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Nickolas Fedack reassigns Medicare benefits to 3 organizations: El Paso County Hospital District (El Paso, TX), El Paso Ams, PLLC (El Paso, TX) and Texas Ams PLLC (Pensacola, FL). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Nickolas Fedack's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Nickolas Fedack accept?

Health plans from Blue Cross and Blue Shield of Texas and Imperial Insurance Companies, Inc. list Nickolas Fedack as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Nickolas Fedack was last updated on July 19, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.